Tags

Type your tag names separated by a space and hit enter

Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
Eur Urol 2014; 65(2):340-7EU

Abstract

BACKGROUND

Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance.

OBJECTIVE

To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC).

DESIGN, SETTING, AND PARTICIPANTS

We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011.

INTERVENTION

All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables.

RESULTS AND LIMITATIONS

Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p=0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p=0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p=0.02). Being a retrospective study was the main limitation.

CONCLUSIONS

Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.

Authors+Show Affiliations

MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.Maine Medical Center, Division of Urology, Portland, ME, USA.Henry Ford Health System, Detroit, MI, USA.Columbia University Medical Center, New York, NY, USA.Memorial Şişli Hospital, Istanbul, Turkey.Mayo Clinic, Scottsdale, AZ, USA.MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.Montefiore Medical Center, UN Hospital Albert Einstein College of Medicine, Bronx, NY, USA.Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address: khurshid.guru@roswellpark.org.Wake Forest University Baptist Medical Center, Salem, NC, USA.University of Michigan Health System, Ann Arbor, MI, USA.Washington University School of Medicine, St. Louis, MO, USA.Henry Ford Health System, Detroit, MI, USA.Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.Washington University School of Medicine, St. Louis, MO, USA.Emory University School of Medicine, Atlanta, GA, USA.Henry Ford Health System, Detroit, MI, USA.Doctor's Hospital of Athens, Athens, Greece.University of North Carolina, NC, USA.Fundacio Puigvert, Barcelona, Spain.Yonsei University Health Systems Severance Hospital, Seoul, Korea.Arthur Smith Institute for Urology, New Hyde Park, NY, USA.University Clinics of Saarland, Homburg, Germany.Weill Cornell Medical College, New York, NY, USA.University Clinics of Saarland, Homburg, Germany.University Clinics of Saarland, Homburg, Germany.University of North Carolina, NC, USA.University of Michigan Health System, Ann Arbor, MI, USA.Karolinska University Hospital, Stockholm, Sweden.City of Hope and Beckman Research Institute, Duarte, CA, USA.Loyola University Medical Center, Maywood, IL, USA.MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

24183419

Citation

Ahmed, Kamran, et al. "Analysis of Intracorporeal Compared With Extracorporeal Urinary Diversion After Robot-assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium." European Urology, vol. 65, no. 2, 2014, pp. 340-7.
Ahmed K, Khan SA, Hayn MH, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65(2):340-7.
Ahmed, K., Khan, S. A., Hayn, M. H., Agarwal, P. K., Badani, K. K., Balbay, M. D., ... Khan, M. S. (2014). Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. European Urology, 65(2), pp. 340-7. doi:10.1016/j.eururo.2013.09.042.
Ahmed K, et al. Analysis of Intracorporeal Compared With Extracorporeal Urinary Diversion After Robot-assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium. Eur Urol. 2014;65(2):340-7. PubMed PMID: 24183419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. AU - Ahmed,Kamran, AU - Khan,Shahid A, AU - Hayn,Matthew H, AU - Agarwal,Piyush K, AU - Badani,Ketan K, AU - Balbay,M Derya, AU - Castle,Erik P, AU - Dasgupta,Prokar, AU - Ghavamian,Reza, AU - Guru,Khurshid A, AU - Hemal,Ashok K, AU - Hollenbeck,Brent K, AU - Kibel,Adam S, AU - Menon,Mani, AU - Mottrie,Alex, AU - Nepple,Kenneth, AU - Pattaras,John G, AU - Peabody,James O, AU - Poulakis,Vassilis, AU - Pruthi,Raj S, AU - Redorta,Joan Palou, AU - Rha,Koon-Ho, AU - Richstone,Lee, AU - Saar,Matthias, AU - Scherr,Douglas S, AU - Siemer,Stefan, AU - Stoeckle,Michael, AU - Wallen,Eric M, AU - Weizer,Alon Z, AU - Wiklund,Peter, AU - Wilson,Timothy, AU - Woods,Michael, AU - Khan,Muhammad Shamim, Y1 - 2013/10/09/ PY - 2013/07/02/received PY - 2013/09/25/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/10/1/medline KW - Complications KW - Extracorporeal urinary diversion KW - Intracorporeal urinary diversion KW - Outcomes KW - Robot-assisted KW - Robotic radical cystectomy KW - Urinary diversion SP - 340 EP - 7 JF - European urology JO - Eur. Urol. VL - 65 IS - 2 N2 - BACKGROUND: Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance. OBJECTIVE: To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC). DESIGN, SETTING, AND PARTICIPANTS: We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011. INTERVENTION: All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables. RESULTS AND LIMITATIONS: Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p=0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p=0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p=0.02). Being a retrospective study was the main limitation. CONCLUSIONS: Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/24183419/Analysis_of_intracorporeal_compared_with_extracorporeal_urinary_diversion_after_robot_assisted_radical_cystectomy:_results_from_the_International_Robotic_Cystectomy_Consortium_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(13)01036-1 DB - PRIME DP - Unbound Medicine ER -