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Intracorporeal versus extracorporeal urinary diversion following robot-assisted radical cystectomy: a meta-analysis, cumulative analysis, and systematic review

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Abstract

Over the last decade, the increased utilization of robot-assisted radical cystectomy (RARC) in the surgical treatment of muscle-invasive bladder cancer has led to an uptrend in intracorporeal urinary diversions (ICUD). However, the operative results comparing ICUD to extracorporeal urinary diversion (ECUD) have varied widely. We performed a meta-analysis to analyze perioperative outcomes and complications of ICUD compared to ECUD following RARC. This study is registered at International Prospective Register of Systematic Reviews (PROSPERO) CRD42020164074. A systematic literature review was conducted using PubMed, EMBASE, and Cochrane databases in August 2019. A total of six studies comparing ICUD vs ECUD were identified and meta-analysis was conducted on these studies. In addition, a cumulative analysis was also performed on 83 studies that reported perioperative outcomes after RARC and ICUD or ECUD. The Weighed Mean Difference of operative time and blood loss between ICUD and ECUD group was (16; 95% confidence interval − 34 to 66) and (− 86; 95% confidence interval − 124 to − 48), respectively. ICUD and ECUD had comparable early (30-day) and mid-term (30–90-day) complication rate (RR 1.19; 95% confidence interval 0.71–2.0; p = 0.5) and (RR 0.91; 95% confidence interval 0.71–1.15 p = 0.4) respectively. In the 83 studies that were included in the cumulative analysis, the mean operative time for ileal conduit and neobladders by ICUD were 307 and 428 min, respectively, compared to ECUD 428 and 426 min, respectively. ICUD and ECUD have comparable short- and mid-term complication rate. The ICUD group has lower blood loss and lower rate of blood transfusion compared to ECUD.

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  1. Department of Urology, University of Florida, 655 8th St W, Jacksonville, FL, 32209, USA

    Karthik Tanneru, Seyed Behzad Jazayeri, Jatinder Kumar, Muhammad Umar Alam, Sabine Nguyen, Soroush Bazargani, Hariharan Palayapalayam Ganapathi, Mark Bandyk, Robert Marino, Shahriar Koochekpour, Shiva Gautam, K. C. Balaji & Joseph Costa

  2. Center for Data Solutions, University of Florida, Jacksonville, FL, USA

    Daniel Norez

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  1. Karthik Tanneru
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KT: protocol/project development, data management, and manuscript writing, SBJ: data analysis, and manuscript writing and review, JK: manuscript writing, MA: manuscript writing, DN: data extraction, data analysis, SN: manuscript editing, SB: manuscript review, HP: manuscript review and editing, MB: manuscript review and editing, RM: manuscript review and editing, SK: manuscript review and editing, KC: protocol development, and manuscript review and editing, SG: data analysis, JC: project development, data review, and manuscript editing.

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Karthik Tanneru, Seyed Behzad Jazayeri, Jatinder Kumar, Muhammad Umar Alam, Daniel Norez, Sabine Nguyen, Soroush Bazargani, Hariharan Ganapathi Palayapalayam, Mark Bandyk, Robert Marino, Shahriar Koochekpour, Shiva Gautam, K.C.Balaji, and Joseph Costa declare that they have no conflict of interest.

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Tanneru, K., Jazayeri, S.B., Kumar, J. et al. Intracorporeal versus extracorporeal urinary diversion following robot-assisted radical cystectomy: a meta-analysis, cumulative analysis, and systematic review. J Robotic Surg 15, 321–333 (2021). https://doi.org/10.1007/s11701-020-01174-4

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