Do patients benefit from total intracorporeal robotic radical cystectomy?: A comparative analysis with extracorporeal robotic radical cystectomy from a Korean multicenter study.

This study aimed to compare complications, perioperative parameters, and oncologic outcomes between robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion (ECUD) and RARC with intracorporeal urinary diversion (ICUD).

Between 2007 and 2017, 362 patients who underwent RARC with ECUD or ICUD at multiple tertiary referral institutions were assessed. The primary endpoints were complication rates. The secondary outcomes were perioperative recovery parameters and oncological outcomes including estimated recurrence-free survival (RFS) and recurrence pattern between the 2 groups. Additionally, the complication rates of 2 expert surgeons with experience of >100 RARCs were analyzed.

The ICUD group showed lower overall, gastrointestinal, and genitourinary complications (p=0.001, p=0.036, and p=0.036, respectively) than the ECUD group. Concerning perioperative outcomes, the ICUD group had a significantly longer operation time (p=0.002), although recovery parameters such as time to flatus passage, oral intake, and length of hospital stay were significantly shorter in this group (p=0.001, p<0.001, and p<0.001, respectively). There was no difference in oncologic outcomes such as positive margin rate (p=0.944) and 2-year RFS (p=0.496), and in the recurrence pattern between groups. In the comparison of the expert surgeons' complication rates, the major and total complication rates did not show differences (p=0.814 and p=0.102, respectively) while the minor complication rates were lower in the ICUD group (p=0.058).

This multi-institutional cohort study demonstrated the benefits of the ICUD approach, as indicated by lower complication rates and better recovery parameters, although the oncological results were similar to those of ECUD.

Investigative and clinical urology. 2019 Dec 18 [Epub]

Ji Sung Shim, Tae Gyun Kwon, Koon Ho Rha, Young Goo Lee, Ji Youl Lee, Byong Chang Jeong, Jong Hyun Pyun, Sung Gu Kang, Seok Ho Kang

Department of Urology, Korea University College of Medicine, Seoul, Korea., Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea., Department of Urology, Yonsei University College of Medicine, Seoul, Korea., Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea., Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea., Department of Urology, Sungkyunkwan University College of Medicine, Seoul, Korea.