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Perioperative Outcomes and Complications after Robotic Radical Cystectomy With Intracorporeal or Extracorporeal Ileal Conduit Urinary Diversion: Head-to-head Comparison From a Single-Institutional Prospective Study

2019; Elsevier BV; Volume: 129; Linguagem: Inglês

10.1016/j.urology.2018.11.059

1527-9995

Riccardo Bertolo, José Agudelo, Juan Garisto, Sherif Armanyous, Amr Fergany, Jihad Kaouk,

Urological Disorders and Treatments

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.Sixty to 66 patients underwent RARC with ileal conduit ICUD and ECUD, respectively. ICUD patients were younger (69 vs 73 years old, P = .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 = .0004). Specifically, no differences were found in postoperative complications while admitted, either overall (ICUD: 16 [26.7%] vs ECUD: 23 [34.8%] patients, P = .3) or major (ICUD: 10 [16.7%] vs ECUD: 14 [21.2%], P = .6); same was for reassessment within 30- and 90-days postoperatively. At multivariable analysis, Charlson's Comorbidity Index ≥3 and blood losses >600 mL predicted complications during the admission (P = .02). Male gender, higher body mass index, and ureteral involvement predicted 30-days complications (P = .04). No differences in oncological outcomes.At head-to-head comparison of 2 expert surgeons, ICUD and ECUD for ileal conduit had comparable perioperative outcomes.