to compare perioperative and oncological outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion ECUD after robot-assisted radical cystectomy (RARC).
From January 2014 to December 2017, data of consecutive patients who underwent RARC performed by 2 institutional surgeons were prospectively collected in a dedicated database (IRB: 251647). Patients were divided in 2 groups according to the operating surgeon, one performing ECUD, the other ICUD. Groups were compared in perioperative outcomes and Clavien complications (during admission, within 30- and 90-days postoperatively). Univariable and multivariable analyses tested the impact of variables of interest on the occurrence of complications at the different time points. Kaplan-Meier method was used to estimate recurrence and metastasis-free survivals.
60 and 66 patients underwent RARC with ileal conduit ICUD and ECUD, respectively. ICUD patients were younger (69 vs 73 years-old, p=0.009). No differences were found in other baseline characteristics and final pathology. Regarding perioperative outcomes, shorter operative time favored ECUD (7 vs 6 hours, p=0.0004). Specifically, no differences were found in postoperative complications while admitted, either overall (ICUD: 16 (26.7%) vs ECUD: 23 (34.8%) patients, p=0.3) or major (ICUD: 10 (16.7%) vs ECUD: 14 (21.2%), p=0.6); same was for reassessment within 30- and 90-days postoperatively. At multivariable analysis, CCI ≥3 and blood losses >600 ml predicted complications during the admission (p=0.02). Male gender, higher BMI and ureteral involvement predicted 30-days complications (p=0.04). No differences in oncological outcomes.
At head-to-head comparison of two expert surgeons, ICUD and ECUD for ileal conduit had comparable perioperative outcomes.
Urology. 2019 Jan 29 [Epub ahead of print]
Riccardo Bertolo, Jose Agudelo, Juan Garisto, Sherif Armanyous, Amr Fergany, Jihad Kaouk
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: .