To analyze the risk of ureteroenteric anastomotic stricture in patients randomized to open or robotic cystectomy with extracorporeal urinary diversion.
We included 118 patients randomized to robotic (n=60) or open (n=58) cystectomy at a single, high-volume institution from March 2010 to April 2013. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher's exact test.
Fifty-eight and 60 patients were randomized to robotic and open cystectomy, respectively. We identified 5 strictures, all in the open group. In patients with at least 1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% CI 1.5%, 17%). Of the 5 strictures, 3 were managed endoscopically while 2 required open revision. There was no evidence that perioperative grade 3-5 complication were associated with development of a stricture (p=1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (p=0.15).
In this study at a high volume center, robotic cystectomy with extracorporeal urinary diversion achieved excellent ureteral anastomotic outcomes. Purported increased risk of stricture is not a reason to avoid robot-assisted radical cystectomy. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed.
BJU international. 2022 Jun 13 [Epub ahead of print]
Chun Huang, Melissa Assel, Benjamin B Beech, Nicole E Benfante, Daniel D Sjoberg, Adam Touijer, Jonathan A Coleman, Guido Dalbagni, Harry W Herr, S Machele Donat, Vincent P Laudone, Andrew J Vickers, Bernard H Bochner, Alvin C Goh
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.