Investig Clin Urol.  2020 Jan;61(1):11-18. 10.4111/icu.2020.61.1.11.

Do patients benefit from total intracorporeal robotic radical cystectomy?: A comparative analysis with extracorporeal robotic radical cystectomy from a Korean multicenter study

• Shim JS
• Kwon TG
• Rha KH
• Lee YG
• Lee JY
• Jeong BC
• Pyun JH
• Kang SG
• Kang SH

• KMID: 2466787
• DOI: http://doi.org/10.4111/icu.2020.61.1.11

Abstract

PURPOSE
This study aimed to compare complications, perioperative parameters, and oncologic outcomes between robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion (ECUD) and RARC with intracorporeal urinary diversion (ICUD).
MATERIALS AND METHODS
Between 2007 and 2017, 362 patients who underwent RARC with ECUD or ICUD at multiple tertiary referral institutions were assessed. The primary endpoints were complication rates. The secondary outcomes were perioperative recovery parameters and oncological outcomes including estimated recurrence-free survival (RFS) and recurrence pattern between the 2 groups. Additionally, the complication rates of 2 expert surgeons with experience of >100 RARCs were analyzed.
RESULTS
The ICUD group showed lower overall, gastrointestinal, and genitourinary complications (p=0.001, p=0.036, and p=0.036, respectively) than the ECUD group. Concerning perioperative outcomes, the ICUD group had a significantly longer operation time (p=0.002), although recovery parameters such as time to flatus passage, oral intake, and length of hospital stay were significantly shorter in this group (p=0.001, p < 0.001, and p < 0.001, respectively). There was no difference in oncologic outcomes such as positive margin rate (p=0.944) and 2-year RFS (p=0.496), and in the recurrence pattern between groups. In the comparison of the expert surgeons' complication rates, the major and total complication rates did not show differences (p=0.814 and p=0.102, respectively) while the minor complication rates were lower in the ICUD group (p=0.058).
CONCLUSIONS
This multi-institutional cohort study demonstrated the benefits of the ICUD approach, as indicated by lower complication rates and better recovery parameters, although the oncological results were similar to those of ECUD.

Keyword

Cystectomy; Recurrence; Robotics; Urinary bladder neoplasms; Urinary diversion

MeSH Terms

Cohort Studies
Cystectomy*
Flatulence
Humans
Length of Stay
Recurrence
Referral and Consultation
Robotics
Surgeons
Urinary Bladder Neoplasms
Urinary Diversion

Figure

• 

  Fig. 1 Comparison of perioperative valuables between the extracorporeal urinary diversion (ECUD) and intracorporeal urinary diversion (ICUD) groups. (A) Total operation time and console time and (B) recovery parameters (time to flatus, time to oral intake, time to urinary catheter removal, and length of hospital stay). *p<0.05, **p<0.001.

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