Factors influencing intraoperative conversion from planned orthotopic to non-orthotopic urinary diversion during radical cystectomy

Abstract

Objectives

To determine and investigate the intraoperative factors that contribute to a change in plan from continent orthotopic neobladder to ileal conduit or continent cutaneous diversion at the time of radical cystectomy.

Subjects and methods

A retrospective review of our prospectively maintained bladder cancer database was performed. Of the 711 patients who underwent radical cystectomy from 2012 to 2016, 387 (54.4%) had given consent to have a NB. Of these 387 patients, 348 (89.9%) ultimately received a neobladder while 34 (8.8%) received an ileal conduit and 5 (1.3%) continent cutaneous diversion. The factors involved in the intraoperative change of plan were examined in this study.

Results

Patients who ultimately received a neobladder were significantly more likely to have clinical node-negative disease (p = 0.045), negative soft tissue margins (p = 0.001), lower body mass index (p = 0.045) and higher volume surgeons (p < 0.001). Oncologic reasons for intraoperative conversions were more common than technical reasons (58.3% vs 35.9%), in both robotic and open surgical techniques. The choice of surgical approach (open vs robotic) did not influence the rate of intraoperative conversion.

Conclusion

The factors influencing intraoperative decision not to perform neobladder are predominantly oncologic rather than technical. A clear understanding of the factors involved in influencing the intraoperative change in the urinary diversion plan may improve shared decision making in patients undergoing radical cystectomy in the future.

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Funding

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Affiliations

Authors

Contributions

SG: protocol/project development, data collection or management, data analysis, manuscript writing/editing. NA: protocol/project development, data collection or management, data analysis, manuscript writing/editing. NH: protocol/project development, data collection or management, data analysis, manuscript writing/editing. GC: Data collection or management, data analysis, manuscript writing/editing. GM: data collection or management, data analysis. JC: data analysis. Schukman: protocol/project development, manuscript writing/editing. HD: protocol/project development, manuscript writing/editing. IG: protocol/project development, manuscript writing/editing. SD: protocol/project development, manuscript writing/editing. MD: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Nariman Ahmadi.

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Conflict of interest

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or 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.

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Ghodoussipour, S., Ahmadi, N., Hartman, N. et al. Factors influencing intraoperative conversion from planned orthotopic to non-orthotopic urinary diversion during radical cystectomy. World J Urol 37, 1851–1855 (2019). https://doi.org/10.1007/s00345-018-2582-2

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Keywords

  • Radical cystectomy
  • Urinary diversion
  • Orthotopic neobladder
  • Ileal conduit