Safe transition from extracorporeal to intracorporeal urinary diversion following robot-assisted cystectomy: a recipe for reducing operative time, blood loss and complication rates

Teck Wei Tan, Rajesh Nair, Sanad Saad, Ramesh Thurairaja, Muhammad Shamim Khan, Teck Wei Tan, Rajesh Nair, Sanad Saad, Ramesh Thurairaja, Muhammad Shamim Khan

Abstract

Purpose: We report the perioperative outcomes and complications after transition from extracorporeal urinary diversion (ECUD) to intracorporeal urinary diversion (ICUD) following robot-assisted radical cystectomy (RARC).

Methods: Analysis of data from a prospectively maintained institutional review board-approved database of 180 patients treated with cystectomy at our institution from April 2015 to October 2017 was performed. 127 patients underwent RARC and received an ileal conduit. Only five patients received a neobladder after RARC and were excluded from analysis.

Results: 68 patients had extracorporeal and 59 intracorporeal ileal conduit after RARC. There were no significant differences in patient demographics and oncological characteristics between the two groups. Of note, intracorporeal ileal conduit was associated with significantly reduced median total operative times (330 vs 375 min, p = 0.019), reduced median estimated blood loss (300 vs 425 ml, p < 0.035) and lower 30-day overall complication rates (48.4 vs 71.4%, p = 0.008) when compared to extracorporeal diversion. However, the median length of stay, 30-90-day complication rates, mortality rates and ureteroileal anastomotic stricture rates were similar in both groups. The median operative time for RARC and intracorporeal ileal conduit was significantly shorter in the second cohort of 29 cases compared to the first 30 cases (300 vs 360 min, p = 0.004). Other outcomes were similar in both cohorts.

Conclusion: In our experience, transition from extracorporeal to intracorporeal diversion after RARC is safe, technically feasible and benefits from shorter operative times, reduced estimated blood loss, and lower 30-day overall complication rates.

Keywords: Cystectomy; Postoperative complications; Robotics; Urinary bladder neoplasms; Urinary diversion.

Conflict of interest statement

Conflict of interest

The authors declare no conflict of interest and do not have anything to disclose.

Ethical approval

The study was approved by the institutional research committee and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

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

References

    1. Alfred Witjes J, Lebret T, Compérat EM, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. 2017;71:462–475. doi: 10.1016/j.eururo.2016.06.020.
    1. Collins JW, Tyritzis S, Nyberg T, et al. Robot-assisted radical cystectomy: description of an evolved approach to radical cystectomy. Eur Urol. 2013;64:654–663. doi: 10.1016/j.eururo.2013.05.020.
    1. Murphy DG, Challacombe BJ, Elhage O, et al. Robotic-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: initial experience. Eur Urol. 2008;54:570–580. doi: 10.1016/j.eururo.2008.04.011.
    1. Tan WS, Sridhar A, Goldstraw M, et al. Robot-assisted intracorporeal pyramid neobladder. BJU Int. 2015;116:771–779. doi: 10.1111/bju.13189.
    1. Desai MM, Gill IS, De Castro Abreu AL, et al. Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients. J Urol. 2014;192:1734–1740. doi: 10.1016/j.juro.2014.06.087.
    1. Yuh B, Wilson T, Bochner B, et al. Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015;67:402–422. doi: 10.1016/j.eururo.2014.12.008.
    1. Parekh DJ, Messer J, Fitzgerald J, et al. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189:474–479. doi: 10.1016/j.juro.2012.09.077.
    1. Khan MS, Gan C, Ahmed K, et al. A single-centre early phase randomised controlled three-arm trial of open, Robotic, and Laparoscopic Radical Cystectomy (CORAL) Eur Urol. 2016;69:613–621. doi: 10.1016/j.eururo.2015.07.038.
    1. Nix J, Smith A, Kurpad R, et al. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57:196–201. doi: 10.1016/j.eururo.2009.10.024.
    1. Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042–1050. doi: 10.1016/j.eururo.2014.11.043.
    1. Wilson TG, Guru K, Rosen RC, et al. Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena consensus panel. Eur Urol. 2015;67:363–375. doi: 10.1016/j.eururo.2014.12.009.
    1. Guru K, Seixas-Mikelus SA, Hussain A, et al. Robot-assisted intracorporeal ileal conduit: marionette technique and initial experience at Roswell Park Cancer Institute. Urology. 2010;76:866–871. doi: 10.1016/j.urology.2009.12.082.
    1. 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;65:340–347. doi: 10.1016/j.eururo.2013.09.042.
    1. Pyun JH, Kim HK, Cho S, et al. Robot-Assisted Radical cystectomy with total intracorporeal urinary diversion: comparative analysis with extracorporeal. J Laparoendosc Adv Surg Tech A. 2016;26:349–356. doi: 10.1089/lap.2015.0543.
    1. Desai MM, de Abreu ALC, Goh AC, et al. Robotic intracorporeal urinary diversion: technical details to improve time efficiency. J Endourol. 2014;28:1320–1327. doi: 10.1089/end.2014.0284.
    1. Novara G, Catto JWF, Wilson T, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67:376–401. doi: 10.1016/j.eururo.2014.12.007.
    1. Sammour T, Kahokehr A, Chan S, et al. The humoral response after laparoscopic versus open colorectal surgery: a meta-analysis. J Surg Res. 2010;164:28–37. doi: 10.1016/j.jss.2010.05.046.
    1. Chen HH, Wexner SD, Iroatulam AJ, et al. Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus. Dis Colon Rectum. 2000;43:61–65. doi: 10.1007/BF02237245.
    1. . Trial to compare robotically assisted radical cystectomy with open radical cystectomy (iROC).

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir