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Robot-assisted radical cystectomy with intracorporeal urinary diversion decreases postoperative complications only in highly comorbid patients: findings that rely on a standardized methodology recommended by the European Association of Urology Guidelines

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Abstract

Introduction

The available studies comparing robot-assisted radical cystectomy (RARC) with intracorporeal (ICUD) vs. extracorporeal (ECUD) urinary diversion have not relied on a standardized methodology to report complications and did not assess the effect of different approaches on postoperative outcomes.

Materials

Two hundred and sixty seven patients treated with RARC at a single center were assessed. A retrospective analysis of data prospectively collected according to a standardized methodology was performed. Multivariable logistic regression models (MVA) assessed the impact of ICUD vs. ECUD on intraoperative complications, prolonged length of stay (LOS), 30-day Clavien Dindo (CD) ≥ 2 complications and readmission rate. Interaction terms tested the impact of the approach on different patient subgroups. Lowess graphically depicted the probability of CD ≥ 2 after ICUD or ECUD according to patient baseline characteristics.

Results

Overall, 162 ICUD vs 105 ECUD (61 vs. 39%) were performed. Intraoperative complications were recorded in 24 patients. The median LOS and readmission rate were 11 vs. 13 (p = 0.02) and 24 vs. 22% (p = 0.7) in ICUD vs. ECUD, respectively. Overall, 227 postoperative complications were recorded. The overall rate of CD ≥ 2 was 35 and 43% in patients with ICUD vs. ECUD, respectively (p = 0.2). At MVA, the approach type was not an independent predictor of any postoperative outcomes (all p ≥ 0.4). Age-adjusted Charlson Comorbidity Index (ACCI) was associated with an increased risk of CD ≥ 2 (OR: 1.2, p = 0.006). We identified a significant interaction term between ACCI and approach type (p = 0.04), where patients with ICUD had lower risk of CD ≥ 2 relative to those with ECUD with increasing ACCI.

Conclusions

Relying on a standardized methodology to report complications, we observed that highly comorbid patients who undergo ICUD have lower risk of postoperative complications relative to those patients who received ECUD.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflicts of interest in preparing this article.

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Authors and Affiliations

  1. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy

    Elio Mazzone

  2. Vita-Salute San Raffaele University, Milan, Italy

    Elio Mazzone, Ruben De Groote, Geert De Naeyer & Peter Schatteman

  3. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium

    Elio Mazzone, Frederiek D’Hondt, Sergi Beato, Iulia Andras, Edward Lambert, Jonathan Vollemaere, Marcio Covas Moschovas, Ruben De Groote, Geert De Naeyer, Peter Schatteman, Alexandre Mottrie & Paolo Dell’Oglio

  4. Orsi Academy, Melle, Belgium

    Elio Mazzone, Frederiek D’Hondt, Sergi Beato, Iulia Andras, Edward Lambert, Jonathan Vollemaere, Marcio Covas Moschovas, Alexandre Mottrie & Paolo Dell’Oglio

  5. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Dell’Oglio

  6. AdventHealth Global Robotics Institute, Celebration, FL, USA

    Marcio Covas Moschovas

Authors
  1. Elio Mazzone
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  2. Frederiek D’Hondt
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  12. Paolo Dell’Oglio
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Contributions

Mazzone, D’Hondt, and Dell’Oglio: Conception and design, Methodology. Beato, Andras, Lambert, and Vollemaere: Data curation. Mazzone and Dell’Oglio: Formal analysis. Funding acquisition: None. Investigation: none. De Naeyer, Schatteman, and Mottrie: Project administration. Resources: none. Mazzone: Software. De Naeyer, Schatteman, and Mottrie: Supervision. Validation: none. Covas Moschovas and De Groote: Visualization. Mazzone and Dell’Oglio: Writing—original draft. D’Hondt and Mottrie: Writing—review and editing. Elio Mazzone had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Elio Mazzone.

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Elio Mazzone 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: none.

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Mazzone, E., D’Hondt, F., Beato, S. et al. Robot-assisted radical cystectomy with intracorporeal urinary diversion decreases postoperative complications only in highly comorbid patients: findings that rely on a standardized methodology recommended by the European Association of Urology Guidelines. World J Urol 39, 803–812 (2021). https://doi.org/10.1007/s00345-020-03237-5

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  • DOI: https://doi.org/10.1007/s00345-020-03237-5

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