Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched-pair comparison in a multicenter cohort in Japan.

To compare the perioperative and oncological outcomes of pure laparoscopic intracorporeal ileal conduit urinary diversion versus extracorporeal ileal conduit urinary diversion after laparoscopic radical cystectomy for bladder cancer in a multicenter cohort in Japan.

A total of 455 patients who underwent laparoscopic radical cystectomy carried out at 10 institutions were included in this retrospective study. The perioperative data of the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups were compared using the propensity score matching method. The Kaplan-Meier curves were obtained to elucidate time to ureteroenteric stricture, reoperation, recurrence and survival.

In total, 72 matched pairs were evaluated for the final analysis. The median follow-up period was 28 and 23 months in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively. The operative time in the intracorporeal ileal conduit urinary diversion group was approximately 1 h longer than that in the extracorporeal ileal conduit urinary diversion group. The early and late postoperative complication rates were similar in both groups, except for the reduced wound-related complication rates in the intracorporeal ileal conduit urinary diversion group. The median days to regular oral food intake were 4 and 5 days in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively (P = 0.014). No significant difference was noted in the occurrence of ureteroenteric strictures and reoperation rate. Furthermore, recurrence-free, cancer-specific, and overall survival rates and recurrence patterns did not significantly differ.

Laparoscopic intracorporeal ileal conduit urinary diversion is a safe, feasible and reproducible procedure with similar postoperative complication rates, ureteroenteric stricture rate and oncological outcomes when compared with extracorporeal ileal conduit urinary diversion, but faster postoperative bowel recovery and decreased wound-related complication rates.

International journal of urology : official journal of the Japanese Urological Association. 2020 Apr 20 [Epub ahead of print]

Toru Kanno, Takahiro Inoue, Mutsushi Kawakita, Katsuhiro Ito, Kazuhiro Okumura, Hitoshi Yamada, Masashi Kubota, Masato Fujii, Yosuke Shimizu, Junji Yatsuda, Go Kobori, Seiji Moroi, Yasumasa Shichiri, Toshiya Akao, Atsuro Sawada, Ryoichi Saito, Takashi Kobayashi, Osamu Ogawa

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan., Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Department of Urology, Kobe City Medical Center General Hospital, Hyogo, Japan., Department of Urology, Tenri Yorozu Hospital, Nara, Japan., Department of Urology, Miyazaki University, Miyazaki, Japan., Department of Urology, Nishi Kobe Medical Center, Hyogo, Japan., Department of Urology, Kumamoto University, Kumamoto, Japan., Department of Urology, Hamamatsu Rosai Hospital, Shizuoka, Japan., Department of Urology, Otsu Municipal Hospital, Shiga, Japan., Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan.