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Multicenter Study
. 2024 Jan;29(1):64-71.
doi: 10.1007/s10147-023-02425-8. Epub 2023 Oct 21.

Comparison of perioperative outcomes and complications between intracorporeal, extracorporeal, and hybrid ileal conduit urinary diversion during robot-assisted radical cystectomy: a comparative propensity score-matched analysis from nationwide multi-institutional study in Japan

Shuichi Morizane  1 , Keita Nakane  2 , Toshiaki Tanaka  3 , Kenji Zennami  4 , Kentaro Muraoka  5 , Shin Ebara  6 , Noriyoshi Miura  7 , Koichi Uemura  8 , Ryuta Sobu  9 , Akio Hoshi  10 , Rikiya Taoka  11 , Mikio Sugimoto  11 , Hisashi Noma  12 , Hiroshi Sunada  13 , Hiroyuki Nishiyama  10 , Tomonori Habuchi  9 , Ichiro Ikeda  8 , Takashi Saika  7 , Kazuhide Makiyama  5 , Ryoichi Shiroki  4 , Naoya Masumori  3 , Takuya Koie  2 , Atsushi Takenaka  14
Affiliations
Multicenter Study

Comparison of perioperative outcomes and complications between intracorporeal, extracorporeal, and hybrid ileal conduit urinary diversion during robot-assisted radical cystectomy: a comparative propensity score-matched analysis from nationwide multi-institutional study in Japan

Shuichi Morizane et al. Int J Clin Oncol. 2024 Jan.

Abstract

Background: To investigate the impact of different urinary diversion (UD) techniques on the peri- and postoperative complications of robot-assisted radical cystectomy (RARC) with ileal conduit.

Methods: We retrospectively analyzed 373 patients undergoing RARC with ileal conduit at 11 institutions in Japan between April 2018 and December 2021. Propensity score weighting was performed to adjust for confounding factors such as age, sex, body mass index, performance status, American Society of Anesthesiologists score, previous abdominal surgery, neoadjuvant chemotherapy, and preoperative high T stage (≥ cT3) and high N stage (≥ cN1). Perioperative complications were then compared among three groups: extracorporeal, intracorporeal, and hybrid urinary diversion (ECUD, ICUD, and HUD, respectively).

Results: A total of 150, 68, and 155 patients received ECUD, HUD, and ICUD, respectively. Bowel reconstruction time and UD time were significantly shorter in the ECUD group (p < 0.001), and console time was significantly longer and blood loss was significantly higher in the ICUD group (p < 0.001). For postoperative complications (Clavien-Dindo Classification grade ≥ 3), surgical site infection (p = 0.004), pelvic abscess (p = 0.013), anastomotic urine leak (p = 0.007), and pelvic organ prolapse (p = 0.011) significantly occurred in the ECUD group. For all grades, ileus was more common in the HUD group, whereas anastomotic stricture was more common in the ECUD group compared with the other groups (p < 0.05).

Conclusions: Severe complications did not increase after HUD and ICUD compared with ECUD; however, console time tended to be longer and blood loss was slightly higher during RARC.

Keywords: Radical cystectomy; Robotics; Urinary diversion.

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