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Perioperative outcomes and complications of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy for bladder cancer: a real-life, multi-institutional french study

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Abstract

Purpose

To compare perioperative outcomes and complications of extracorporeal (ECUD) vs intracorporeal urinary diversion (ICUD) in patients after undergoing robot-assisted radical cystectomy (RARC) at five referral centers in France.

Methods

We retrospectively reviewed our multi-institutional, prospectively-collected database to select patients undergoing RARC between 2010 and 2016 with at least 3 months of follow-up. At each center, the surgery was performed by one surgeon with extensive experience in robotic surgery and radical cystectomy but no prior experience in RARC.

Results

Overall, 108 patients were included. ECUD and ICUD were performed in 34 (31.5%) and 74 (68.5%) patients, respectively. Patient characteristics were comparable among the two groups, except for a higher proportion of patients with high surgical risk (ASA score ≥ 3) in the ECUD group. Ileal conduit and ileal neobladder were performed in 63/108 (58%) and 45/108 (42%) cases, respectively. Ileal conduit was performed more often with an extracorporeal approach while ileal neobladder with an intracorporeal approach. Overall, operative time, length of hospital stay, positive margin rate, and number of lymph nodes removed did not significantly differ among the two cohorts. Estimated blood loss and transfusion rates were significantly higher in the ECUD group. Rate of early (38.2 vs 47.3%, p = 0.4) and late (29.4 vs 18.9%, p = 0.2) surgical complications did not significantly differ between the ECUD and ICUD groups. Results were comparable in the subgroup analysis in the ileal conduit subpopulation.

Conclusion

In our real-life, multi-institutional study, RARC with ICUD achieved perioperative outcomes and complication rates comparable to those of RARC with ECUD.

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Authors and Affiliations

  1. Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France

    Louis Lenfant, Riccardo Campi, Jérôme Parra, Pietro Grande, Christophe Vaessen & Morgan Rouprêt

  2. Department of Urology, Pontchaillou Hospital, CHU Rennes, Rennes, France

    Gregory Verhoest & Vivien Graffeille

  3. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

    Riccardo Campi

  4. Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France

    Alexandra Masson-Lecomte, Dimitri Vordos & Alexandre de La Taille

  5. Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1 Avenue J Pouilhès, 31059, Toulouse Cedex, France

    Mathieu Roumiguie & Marine Lesourd

  6. Hôpital privé d’Antony, 1 rue Velpeau, 92160, Antony, France

    Lionel Taksin

  7. Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France

    Vincent Misraï

  8. Department of Obstetric and Gynaecological Sciences and Urological Sciences, ‘Sapienza’ University, Rome, Italy

    Pietro Grande

  9. Department of Urology, Clinique St Jean du Languedoc, Toulouse, France

    Guillaume Ploussard

  10. Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Pitié-Salpétrière Hospital, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France

    Benjamin Granger

Authors
  1. Louis Lenfant
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  2. Gregory Verhoest
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  3. Riccardo Campi
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  4. Jérôme Parra
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  5. Vivien Graffeille
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  6. Alexandra Masson-Lecomte
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  7. Dimitri Vordos
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  8. Alexandre de La Taille
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  9. Mathieu Roumiguie
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  10. Marine Lesourd
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  11. Lionel Taksin
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  12. Vincent Misraï
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  13. Pietro Grande
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  14. Christophe Vaessen
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  15. Guillaume Ploussard
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  16. Benjamin Granger
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  17. Morgan Rouprêt
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Contributions

LL: data collection and manuscript writing. GV: data collection. RC: manuscript writing. JP: manuscript editing. VG: data collection. AM-L: data collection. DV: data collection. AT: manuscript editing. MR: data collection. ML: data collection. LT: manuscript editing. VM: manuscript editing. PG: manuscript editing. CV: manuscript editing. GP: manuscript editing. BG: data analysis. MR: project development and manuscript editing.

Corresponding author

Correspondence to Morgan Rouprêt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

345_2018_2313_MOESM1_ESM.docx

Supplementary Table 1. Clinical characteristics, perioperative outcomes and complication rates of patients excluded from the study due to intraoperative conversion from robot-assisted radical cystectomy (RARC) to open radical cystectomy (n=9) (DOCX 16 kb)

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Lenfant, L., Verhoest, G., Campi, R. et al. Perioperative outcomes and complications of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy for bladder cancer: a real-life, multi-institutional french study. World J Urol 36, 1711–1718 (2018). https://doi.org/10.1007/s00345-018-2313-8

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  • DOI: https://doi.org/10.1007/s00345-018-2313-8

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