Intracorporeal robot‐assisted radical cystectomy, together with an enhanced recovery programme, improves postoperative outcomes by aggregating marginal gains

Tan, Wei Shen; Tan, Mae-Yen; Lamb, Bernard Charles; Sridhar, Ashwin; Mohammed, Anna; Baker, Hilary; Nathan, Senthil; Briggs, Timothy P.; Tan, Melanie; Kelly, John D.

doi:10.1111/bju.14073

Cited by 62 publications

(35 citation statements)

References 23 publications

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“…In this respect, ICUD‐IC has merits, although the operative time was approximately 1 h longer. Furthermore, it was recently reported that ICUD together with ERAS improved postoperative outcomes by aggregating marginal gains 19 . We expect that the introduction of ERAS can further improve perioperative outcomes in LRC with ICUD‐IC.…”

Section: Discussionmentioning

confidence: 80%

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

et al. 2020

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Abbreviations & Acronyms ASA = American Society of Anesthesiologists Cr = creatine ECUD = extracorporeal urinary diversion ECUD-IC = extracorporeal ileal conduit urinary diversion ERAS = enhanced recovery after surgery Hb = hemoglobin ICUD = intracorporeal urinary diversion ICUD-IC = intracorporeal ileal conduit urinary diversion IQR = interquartile range LRC = laparoscopic radical cystectomy RARC = robot-assisted radical cystectomy SD = standard deviation Objectives: To compare the perioperative and oncological outcomes of pure laparoscopic intracorporeal ileal conduit urinary diversion versus extracorporeal ileal conduit urinary diversion after laparoscopic radical cystectomy for bladder cancer in a multicenter cohort in Japan. Method: A total of 455 patients who underwent laparoscopic radical cystectomy carried out at 10 institutions were included in this retrospective study. The perioperative data of the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups were compared using the propensity score matching method. The Kaplan-Meier curves were obtained to elucidate time to ureteroenteric stricture, reoperation, recurrence and survival. Results: In total, 72 matched pairs were evaluated for the final analysis. The median follow-up period was 28 and 23 months in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively. The operative time in the intracorporeal ileal conduit urinary diversion group was approximately 1 h longer than that in the extracorporeal ileal conduit urinary diversion group. The early and late postoperative complication rates were similar in both groups, except for the reduced wound-related complication rates in the intracorporeal ileal conduit urinary diversion group. The median days to regular oral food intake were 4 and 5 days in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively (P = 0.014). No significant difference was noted in the occurrence of ureteroenteric strictures and reoperation rate. Furthermore, recurrence-free, cancerspecific, and overall survival rates and recurrence patterns did not significantly differ. Conclusions: Laparoscopic intracorporeal ileal conduit urinary diversion is a safe, feasible and reproducible procedure with similar postoperative complication rates, ureteroenteric stricture rate and oncological outcomes when compared with extracorporeal ileal conduit urinary diversion, but faster postoperative bowel recovery and decreased wound-related complication rates.

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Section: Discussionmentioning

confidence: 80%

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

et al. 2020

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“…The general characteristics of the eligible studies are summarized in Table . The present systematic review includes six RCTs comprising 581 patients, and 31 NRCTs comprising 48 392 patients published between 2010 and 2018. Of these, 20 studies enrolled patients from North America, nine from Europe and eight from Asia.…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, early randomized controlled trials failed to find any differences in complications at 90 days between RARC and ORC . As the last meta‐analysis on this subject was carried out in 2017, a significant body of novel data including both randomized (RCTs) and NRCTs have emerged, adding new evidence to the topic …”

Section: Introductionmentioning

confidence: 99%

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

et al. 2019

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To compare postoperative complications and health‐related quality of life of patients undergoing robot‐assisted radical cystectomy with those of patients undergoing open radical cystectomy. A systematic search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. A pooled meta‐analysis was carried out to assess the differences between robot‐assisted radical cystectomy and open radical cystectomy according to randomized and non‐randomized comparative studies, respectively. We identified six randomized comparative studies and 31 non‐randomized comparative studies. Most robot‐assisted radical cystectomy patients were treated with extracorporeal urinary diversion. Robot‐assisted radical cystectomy was associated with longer operative times, and lower blood loss and transfusion rates compared with open radical cystectomy in both randomized comparative studies and non‐randomized comparative studies. There was no significant difference between robot‐assisted radical cystectomy and open radical cystectomy in the rate of patients with any or major complications within 90 days both in randomized comparative studies and non‐randomized comparative studies. Non‐randomized comparative studies reported a lower rate of complications at 30 days, mortality at 90 days and length of stay for patients treated with robot‐assisted radical cystectomy, which were not confirmed in randomized comparative studies. Additionally, there were no differences in postoperative quality of life score assessment at 3 and 6 months between robot‐assisted radical cystectomy and open radical cystectomy. Robot‐assisted radical cystectomy is associated with less blood loss and lower transfusion rates. There is no difference in complications, length of stay, mortality, and quality of life between robot‐assisted radical cystectomy and open radical cystectomy. Data from non‐randomized comparative studies favor perioperative outcomes in robot‐assisted radical cystectomy patients, the failure to confirm in randomized comparative studies, likely due to bias in study design and reporting. Further randomized comparative studies comparing postoperative complications and quality of life between robot‐assisted radical cystectomy with intracorporeal urinary diversion and open radical cystectomy are required to assess potential differences between these two surgical approaches.

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“…If the stress response after surgery weakens physiological capacity and increases postoperative mortality, then enhancement in the quality of care for patients undergoing RC must focus on the modifiable factors to improve the physiological reserve of patients. Enhanced recovery after surgery (ERAS) protocols are common in RC and have demonstrated significantly reduced length of stay and costs, with comparable rates of complications and readmission . Data have also recently emerged on the value of preoperative interventions often referred to as ‘prehabilitation’, which aim to enhance potentially modifiable patient factors .…”

Section: Discussionmentioning

confidence: 99%

Examining the relationship between complications and perioperative mortality following radical cystectomy: a population‐based analysis

et al. 2019

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ObjectiveTo examine the incidence of perioperative complications after radical cystectomy (RC) and assess their impact on 90-day postoperative mortality during the index stay and upon readmission. Patients and methodsA total of 57 553 patients with bladder cancer (unweighted cohort: 9137 patients) treated with RC, at 360 hospitals in the USA between 2005 and 2013 within the Premier Healthcare Database, were used for analysis. The 90-day perioperative mortality was the primary outcome. Multivariable regression was used to predict the probability of mortality; models were adjusted for patient, hospital, and surgical characteristics. ResultsAn increase in the number of complications resulted in an increasing predicted probability of mortality, with a precipitous increase if patients had four or more complications compared to one complication during hospitalisation following RC (index stay; 1.0-9.7%, P < 0.001) and during readmission (2.0-13.1%, P < 0.001). A readmission complication nearly doubled the predicted probability of postoperative mortality as compared to an initial complication (3.9% vs 7.4%, P < 0.001). During the initial hospitalisation cardiac-(odds ratio [OR] 3.1, 95% confidence interval [CI] 1.9-5.1), pulmonary-(OR 4.8, 95% CI 2.8-8.4), and renal-related (OR 3.6, 95% CI 2-6.7) complications had the most significant impact on the odds of mortality across categories examined. ConclusionsThe number and nature of complications have a distinct impact on mortality after RC. As complications increase there is an associated increase in perioperative mortality.

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Intracorporeal robot‐assisted radical cystectomy, together with an enhanced recovery programme, improves postoperative outcomes by aggregating marginal gains

Cited by 62 publications

References 23 publications

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

Perioperative and oncological outcomes of laparoscopic radical cystectomy with intracorporeal versus extracorporeal ileal conduit: A matched‐pair comparison in a multicenter cohort in Japan

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

Examining the relationship between complications and perioperative mortality following radical cystectomy: a population‐based analysis

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