Intracorporeal versus extracorporeal urinary diversion after robot‐assisted radical cystectomy: a pooled analysis

Abstract

Background: To compare intracorporeal urinary diversion (ICUD) with extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC) for surgery safety, postoperative recovery, complication, and prognosis. Methods:We performed a literature search on PubMed, Embase, Medline and the Cochrane Library based on all randomized controlled trials (RCTs) and observational comparative studies related to study topics published before July 14th, 2020. Then systematic review and meta-analysis was performed.Results: 13 retrospective studies containing 4,755 patients were identified. In terms of surgery safety, with similar operative time, ICUD group showed less estimated blood loss (EBL) (P<0.0001) and lower blood transfusion rate (P=0.006). In terms of postoperative recovery, with similar hospital stay, ICUD group showed earlier recovery on flatus (P<0.001) and oral intake (P<0001). In aspect of complications, there were no significant differences between ICUD and ECUD groups, except for gastrointestinal system complications. ICUD group had lower gastrointestinal complications rate than ECUD group (P=0.002). In aspect of prognosis outcomes, with similar mortality, ICUD group had lower recurrence rate than ECUD group (P=0.004).Conclusions: Based on the current evidence, ICUD procedure is excellence in surgery safety, postoperative recovery, complications, and prognosis. However, the observational studies reduced the level of evidence, larger randomized trials are needed to confirm these findings.

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

“…Regarding postoperative complications within 90 days, grade ≥ 3 complications such as surgical site infection, pelvic abscess, and anastomotic urine leak were more common in the ECUD group than in the ICUD and HUD groups. Hussein et al reported a signi cantly higher incidence of infection in the ICUD group [14], but no other studies have reported higher incidences of surgical site infection and pelvic abscess in the ECUD group [12,13,[15][16][17][18][19]. Our study also showed that ICUD did not increase wound infections or pelvic abscesses caused by the spread of intestinal bacteria into the abdominal cavity.…”

“…In RC, the bladder should not be removed, but UD should be performed subsequently. ECUD or ICUD as the more ideal UD technique with fewer complications remains debatable [12][13][14][15][16][17][18][19]. Additionally, comparison of HUD with ECUD and ICUD has not yet been reported; thus, this study is the rst to report it.…”

Update on robotic cystectomy

“…Several meta-analyses have been published in the last two years that aggregate large amounts of data to compare iRARC, eRARC, and ORC [35–46]; they report similar findings as above. Generally, when comparing RARC (inclusive of both intracorporeal and extracorporeal technique) and ORC they report equivalent oncological outcomes and an advantage in lower EBL, lower transfusion rates, shorter length of stay, and quicker return to regular diet.…”

Urinary diversions for radical cystectomy: a review of complications and their management

“…All the urinary diversions in the RAZOR trial were performed extracorporeally, which can influence complication results [6] . However, performing the urinary diversion in an extracorporeal or intracorporeal way also carries similar complication rates, with a trend towards less gastrointestinal complications in the intracorporeal urinary diversion [7,8] . Early complications are less related to the type of urinary diversion than late complications [3] .…”

“…Each diversion type has its own specific complication, related not only to the construction of the diversion but also to the chosen intestinal segment. The surgical approach (open vs. robot-assisted and extracorporeal vs. intracorporeal) is not related to specific complications [6,7] .…”