Comparison of renal function after open radical cystectomy, extracorporeal robot assisted radical cystectomy, and intracorporeal robot assisted radical cystectomy

Lone, Zaeem; Murthy, P. Balakrishna; Zhang, JJ H.; Ericson, Kyle; Thomas, Lewis J.; Khanna, Abhinav; Haber, Georges Pascal; Lee, Byron

doi:10.1016/j.urolonc.2020.09.018

Cited by 11 publications

(13 citation statements)

References 24 publications

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“…Data about OT were extracted from seventeen studies 13 – 17 , 25 – 27 , 29 – 31 , 33 , 34 , 37 , 39 – 41 , with high heterogeneity among studies (I 2 =97.2%), so we used random effect model. Our final meta-analysis indicated that ORC group was less than iRARC group in terms of OT (WMD: 68.54; 95% CI 47.41–89.67; P <0.001, Fig.…”

Section: Resultsmentioning

confidence: 99%

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Fu,

Shi,

Fan

et al. 2024

International Journal of Surgery

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Background: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. Methods: The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. Results: Twenty-two studies involving 7,020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [EBL WMD: −555.52; 95% CI, −681.64 to −429.39; P<0.001], blood transfusion rate [OR: 0.16; 95% CI, 0.09 to 0.28; P<0.001], length of hospital stay [LOS WMD: −2.05; 95% CI, −2.93 to −1.17; P<0.001], Clavien-Dindo grades ≥III complication rate [30d: OR: 0.57; 95% CI 0.44 to 0.75; P<0.001; 90d: OR: 0.71; 95% CI 0.60 to 0.84; P<0.001], and positive surgical margin [PSM OR: 0.65; 95% CI 0.49 to 0.85; P=0.002]. However, iRARC had a longer operative time [OT WMD: 68.54; 95%CI 47.41 to 89.67; P<0.001] and a higher rate of ureteroenteric stricture [ UES OR: 1.56; 95% CI 1.16 to 2.11; P=0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades<III complication rate for iRARC were similar to that for ORC. Interestingly, the results of subgroup analysis revealed no difference in EBL between iRARC and ORC when the diversion type was neobladder. When the ileal conduit was selected as the diversion type, the LOS was similar in both procedures. Conclusion: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.

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Section: Resultsmentioning

confidence: 99%

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Fu,

Shi,

Fan

et al. 2024

International Journal of Surgery

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“…We demonstrate that the development of advanced CKD is common following radical cystectomy, with one in four patients experiencing an eGFR of <30 ml/min/1.73 m 2 within a year of surgery. Previous studies describing kidney function decline following radical cystectomy have primarily been single-institution series stratified by diversion type and, recently, surgical approach [4] , [9] , [17] , [25] , [26] . This report extends these findings through the evaluation of a large national cohort with longitudinal follow-up and access to long-term kidney function and survival data.…”

Section: Discussionmentioning

confidence: 99%

Renal Morbidity Following Radical Cystectomy in Patients with Bladder Cancer

Schmidt

Velaer

Thomas

et al. 2022

European Urology Open Science

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“…This number is comparable to the one observed in the current study. Lone et al reported that 64% of patients who underwent either ORC, RARC with ICUD, or RARC with ECUD experienced a decline in eGFR ≥ 10 mL/min/1.73 m 2 with no differences between the surgery type [ 5 ]. It should be borne in mind that UCL in RC has not been extensively studied since it was only after the utilization of laparoscopic and robotic technologies that surgeons began ureteral clamping to continue intracorporeal procedures after ligating the ureters [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the phase 3 RAZOR trial, the rate of acute renal failure (as defined in that study) was 11%, and no difference in its incidence was observed in comparison with ORC [ 3 ]. Additionally, mid-term renal function is reported to be comparable between ORC and RARC or across different urinary diversions [ 5 ]. However, the level of evidence is not very strong, and therefore, maximum effort is warranted to avoid acute kidney injury (AKI) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, mid-term renal function is reported to be comparable between ORC and RARC or across different urinary diversions [ 5 ]. However, the level of evidence is not very strong, and therefore, maximum effort is warranted to avoid acute kidney injury (AKI) [ 5 ]. Both AKI and long-term renal function outcomes are attributed to various factors, including preoperative renal function, hypertension, and diabetes; therefore, it is quite challenging to evaluate the effects of ureteral clamping on short-term renal function.…”

Section: Introductionmentioning

confidence: 99%

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Association between Ureteral Clamping Time and Acute Kidney Injury during Robot-Assisted Radical Cystectomy

et al. 2021

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Robot-assisted radical cystectomy (RARC) is replacing open radical cystectomy (ORC) and requires clamping of the ureters, resulting in a predisposition to postrenal acute kidney injury (AKI). We investigated the association between ureteral clamping or its duration and acute/chronic postoperative kidney function. Patients who underwent radical cystectomy (robotic or open) at two tertiary institutions during 2002–2021 were retrospectively enrolled. In those who underwent RARC, the maximum postoperative percentage serum creatinine level (%sCre) change was plotted against ureteral clamping duration. They were divided into two groups using the median clamping time (210 min), and the maximum %sCre change and percentage estimated glomerular filtration rate (%eGFR) change at 3–6 months (chronic) were compared between the ORC (no clamp), RARC < 210, and RARC ≥ 210 groups. In 44 RARC patients, a weak correlation was observed between the duration of ureteral clamping and %Cre change (R2 = 0.22, p = 0.001). Baseline serum creatinine levels were comparable between the groups. However, %sCre change was significantly larger in the RARC ≥ 210 group (N = 17, +32.1%) than those in the RARC < 210 (N = 27, +6.1%) and ORC (N = 76, +9.5%) groups (both, p < 0.001). Chronic %eGFR change was comparable between the groups. Longer clamping of the ureter during RARC may precipitate AKI; therefore, the clamping duration should be minimized.

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Comparison of renal function after open radical cystectomy, extracorporeal robot assisted radical cystectomy, and intracorporeal robot assisted radical cystectomy

Cited by 11 publications

References 24 publications

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Renal Morbidity Following Radical Cystectomy in Patients with Bladder Cancer

Association between Ureteral Clamping Time and Acute Kidney Injury during Robot-Assisted Radical Cystectomy

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