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Perioperative Outcomes of Robot-Assisted Radical Cystectomy with Intracorporeal Versus Extracorporeal Urinary Diversion

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to investigate and compare the perioperative outcomes of intracorporeal urinary diversion (ICUD) versus extracorporeal urinary diversion (ECUD) following robotic-assisted radical cystectomy (RARC) in patients with localized bladder cancer from the Asian Robot-Assisted Radical Cystectomy (RARC) Consortium.

Methods

The Asian RARC registry was a multicenter registry involving nine centers in Asia. Consecutive patients who underwent RARC were included. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed and compared between the ICUD and ECUD groups. Postoperative complications were the primary outcomes, whereas secondary outcomes were the estimated blood loss and the duration of hospitalization. Multivariate regression analyses were performed to adjust potential confounders.

Results

From 2007 to 2020, 556 patients underwent RARC; 55.2% and 44.8% had ICUD and ECUD, respectively. ICUD group had less estimated blood loss (423.1 ± 361.1 vs. 541.3 ± 474.3 mL, p = 0.002) and a shorter hospital stay (15.7 ± 12.3 vs 17.8 ± 11.6 days, p = 0.042) than the ECUD group. Overall complication rates were similar between the two groups. Upon multivariate analysis, ICUD was associated with less estimated blood loss (Regression coefficient: − 143.06, 95% confidence interval [CI]: − 229.60 to − 56.52, p = 0.001) and a shorter hospital stay (Regression coefficient: − 2.37, 95% CI: − 4.69 to − 0.05, p = 0.046). In addition, ICUD was not associated with any increased risks of minor, major, and overall complications.

Conclusions

RARC with ICUD was safe and technically feasible with similar postoperative complication rates as ECUD, with additional benefits of reduced blood loss and a shorter hospitalization.

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Author information

Authors and Affiliations

  1. S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

    Jeremy Yuen-Chun Teoh FRCSEd, Erica On-Ting Chan MBChB, Timothy Shing-Fung Chow MBChB, Alex Mok MBChB & Eddie Shu-Yin Chan FRCSEd

  2. European Association of Urology Young Academic Urologists, Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands

    Jeremy Yuen-Chun Teoh FRCSEd

  3. Department of Urology, School of Medicine, Korea University, Seoul, Republic of Korea

    Seok-Ho Kang MD

  4. Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Manish I. Patel MBBS, PhD

  5. Department of Urology, Westmead Hospital, Westmead, NSW, Australia

    Manish I. Patel MBBS, PhD

  6. Graduate School of Medicine, Department of Urology, Juntendo University, Tokyo, Japan

    Satoru Muto MD, PhD & Shigeo Horie MD, PhD

  7. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan

    Cheng-Kuang Yang MD

  8. Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Shingo Hatakeyama MD, PhD & Chikara Ohyama MD, PhD

  9. Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Ruiyun Zhang PhD & Haige Chen PhD

  10. Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Kittinut Kijvikai MD

  11. Department of Urology, Sengkang General Hospital, Singapore, Singapore

    Lui-Shiong Lee MBBS, MRCS, MMed

  12. Department of Urology, Singapore General Hospital, Singapore, Singapore

    Lui-Shiong Lee MBBS, MRCS, MMed

Authors
  1. Jeremy Yuen-Chun Teoh FRCSEd
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  2. Erica On-Ting Chan MBChB
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  3. Seok-Ho Kang MD
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  5. Satoru Muto MD, PhD
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  6. Cheng-Kuang Yang MD
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  7. Shingo Hatakeyama MD, PhD
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  8. Timothy Shing-Fung Chow MBChB
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  11. Kittinut Kijvikai MD
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  12. Lui-Shiong Lee MBBS, MRCS, MMed
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  13. Haige Chen PhD
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  14. Chikara Ohyama MD, PhD
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  15. Shigeo Horie MD, PhD
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  16. Eddie Shu-Yin Chan FRCSEd
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Corresponding author

Correspondence to Jeremy Yuen-Chun Teoh FRCSEd.

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Appendix 1

Appendix 1

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Table 6 RARC case breakdown by place (n = 556)
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Teoh, J.YC., Chan, E.OT., Kang, SH. et al. Perioperative Outcomes of Robot-Assisted Radical Cystectomy with Intracorporeal Versus Extracorporeal Urinary Diversion. Ann Surg Oncol 28, 9209–9215 (2021). https://doi.org/10.1245/s10434-021-10295-5

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  • DOI: https://doi.org/10.1245/s10434-021-10295-5

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