Intracorporeal versus Extracorporeal Neobladder after Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

To compare perioperative and oncologic outcomes of intracorporeal (ICNB) and extracorporeal neobladder (ECNB) following robot assisted radical cystectomy (RARC) from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC).

A retrospective review of IRCC database between 2003 and 2020 (3742 patients from 33 institutions across 14 countries) was performed (I-97906). The Cochran-Armitage trend test was used to assess utilization of ICNB over time. Multivariate logistic regression models were fit to evaluate variables associated with receiving ICNB, overall complications, high-grade complications, and readmissions after RARC. Kaplan Meier curves were used to depict recurrence-free (RFS), disease-specific (DSS), and overall survival (OS).

411 patients received neobladder, 64% underwent ICNB. ICNB utilization increased significantly over time (p<0.01). Patients who received ICNB were readmitted and received neoadjuvant chemotherapy (NAC) more frequently (36% vs 24%, p=0.03, 35% vs 8%, p<0.01, respectively). ICNB was associated with older age (OR 1.04, 95% CI 1.01-1.07, p=0.001), receipt of NAC (OR 4.63, 95% CI 2.34-9.18, p<0.01), and more recent RARC era (2016-2020) (OR 12.6, 95% CI 5.6-28.4, p<0.01). On multivariate analysis, ICNB (OR 5.43, 95% CI 2.34-12.58, p<0.01), positive surgical margin (OR 4.88, 95% CI 1.29-18.42, p=0.019), longer operative times (OR 1.26, 95% CI 1.00-1.58, p=0.048), and institutional annual RARC volume (OR 1.09, 95% CI 1.05-1.12, p<0.01) were associated with readmissions.

Utilization of ICNB increased significantly over time. Patients who underwent RARC and ICNB had shorter hospital stays and fewer 30-d reoperations but were readmitted more frequently compared to those who underwent ECNB.

Urology. 2021 Oct 25 [Epub ahead of print]

Zafardjan Dalimov, Umar Iqbal, Zhe Jing, Peter Wiklund, Jihad Kaouk, Eric Kim, Carl Wijburg, Andrew A Wagner, Morgan Roupret, Prokar Dasgupta, Franco Gaboardi, Lee Richstone, Ahmed Aboumohamed, Ahmed A Hussein, Khurshid A Guru

Department of Urology, Roswell Park Comprehensive Cancer Center, NY, USA., Karolinska Institute, Stockholm, Sweden., Cleveland Clinic, OH, USA., Washington University St. Louis, MO, USA., Rijnstate Hospital- Stichting, Arnhem, Gelderland, the Netherlands., Beth Israel Deaconess Medical Center, MA, USA., Hôpital Pitié-Salpétrière, Île-de-France, France., Guy's Hospital, Greater London, United Kingdom., Luigi Sacco (San Raffaele Turro), Lombardy, Italy., Arthur Smith Institute for Urology, NY, USA., Montefiore Medical Center (Albert Einstein College of Medicine), NY, USA., Department of Urology, Roswell Park Comprehensive Cancer Center, NY, USA. Electronic address: .

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