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 - 28/07/19
ABSTRACT |
Objective |
To compare perioperative and oncological outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC).
Methods |
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.
Results |
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.
Conclusion |
At head-to-head comparison of 2 expert surgeons, ICUD and ECUD for ileal conduit had comparable perioperative outcomes.
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Financial Disclosure: Jihad H. Kaouk certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Endocare, Inc, Intuitive. - J.H. Kaouk (consultant). The remaining authors (Riccardo Bertolo, Jose Agudelo, Juan Garisto, Sherif Armanyous and Amr Fergany) have nothing to disclose. |
Vol 129
P. 98-105 - juillet 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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