Comparison of perioperative outcomes and complications of robot assisted radical cystectomy with extracorporeal vs intracorporeal urinary diversion.

Abstract

OBJECTIVES:

To compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer.

MATERIAL AND METHODS:

Retrospective revision of 43 patients who underwent RARC for bladder cancer between 2015-2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy.

RESULTS:

Forty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 minutes (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, P=.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, P=.044).

CONCLUSIONS:

RARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.

• Authors: A Carrion, A Piñero, C Raventós, F Lozano, F Díaz, J Morote
• Journal: Actas urologicas espanolas (Actas Urol Esp (Engl Ed)) 2019 Jul - Aug Vol. 43 Issue 6 Pg. 277-283 ISSN: 2173-5786 [Electronic] Spain
• Vernacular Title: Comparación de los resultados perioperatorios de la cistectomía radical asistida por robot con derivación urinaria extracorpórea vs. intracorpórea.
• PMID: 31036392 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Constriction, Pathologic (etiology)
• Cystectomy (adverse effects, methods)
• Female
• Humans
• Length of Stay
• Lymph Node Excision
• Male
• Middle Aged
• Operative Time
• Postoperative Complications (etiology)
• Retrospective Studies
• Robotic Surgical Procedures (adverse effects, methods)
• Treatment Outcome
• Urethra (surgery)
• Urinary Bladder (surgery)
• Urinary Bladder Neoplasms (pathology, surgery)
• Urinary Diversion (adverse effects, methods)