Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and extracorporeal (ECUD) urinary diversion following robot-assisted radical cystectomy (RARC). A systematic literature search of articles was performed in PubMed®, Web of Science®, and Scopus® databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We included studies that compared patients who underwent RARC with ICUD to those with ECUD. Twelve studies including 3067 patients met the eligibility criteria. There were no significant differences between ICUD and ECUD in overall and major complications, regardless of the period (short-term [≤ 30 days] or mid-term [> 30 days]). Subgroup analyses demonstrated that ICUD performed by high-volume centers exhibited a significantly reduced risk of major complications (short-term: OR 0.57, 95% CI 0.37–0.86, p = 0.008, mid-term: OR 0.66, 95% CI 0.46–0.94, p = 0.02). Patients who underwent ICUD had lower estimated blood loss (MD -102.3 ml, 95% CI − 132.8 to − 71.8, p < 0.00001), less likely to receive blood transfusion rates (OR 0.36, 95% CI 0.20–0.62, p = 0.00003); and these findings were consistent in subgroup analyses by low-volume centers (MD-121.6 ml, 95% CI − 160.9 to − 82.3, p < 0.00001 and OR 0.36, 95% CI 0.20–0.62, p = 0.00003, respectively). ICUD had a higher lymph node yield (MD 3.68, 95% CI 0.80–6.56, p = 0.01). Patients receiving ICUD provided comparable complications, superior perioperative outcomes, and similar oncological outcomes compared with ECUD. Centralization of patients may contribute to a reduction of postoperative complications, while maintaining the advantages.

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

“…In experienced hands, ICUD has been reported to be associated with a reduced risk for major complications (84), similar to all procedures performed by high-volume surgeons in high-volume centers. Estimated blood loss and blood transfusion rates are significantly lower in patients with ICUD than in patients with ECUD, but readmission rates were reported to be higher for ICUD (75,84). Because ICUD is still in its infancy, prospective studies with long-term oncologic and functional outcomes specifically designed to assess outcomes in females are still lacking (85).…”

“…As RARC is more widely available nowadays, ICUD entered the stage and has become increasingly popular (74,75,82,83). Systematic reviews and meta-analyses showed equivalent complication rates for ICUD compared to extracorporeal UD (ECUD) (84). In experienced hands, ICUD has been reported to be associated with a reduced risk for major complications (84), similar to all procedures performed by high-volume surgeons in high-volume centers.…”

“…Systematic reviews and meta-analyses showed equivalent complication rates for ICUD compared to extracorporeal UD (ECUD) (84). In experienced hands, ICUD has been reported to be associated with a reduced risk for major complications (84), similar to all procedures performed by high-volume surgeons in high-volume centers. Estimated blood loss and blood transfusion rates are significantly lower in patients with ICUD than in patients with ECUD, but readmission rates were reported to be higher for ICUD (75,84).…”

Approach to Lower Urinary Tract Reconstruction: A Survey of Adult and Pediatric Urologist Perspectives and Experiences

“…One of our observations is that this often occurred at the point in the study when the focus became these relatively less commonly performed procedures and may further skew the responses received. Despite the fact that intracorporeal diversions overall have increased in use particularly in centralized study sites (20)(21)(22), based on the low number of respondents in this study that have completed intracorporeal procedures in the past year, our sample has not captured this trend. Providing that over half of the participants reside in the United States and Europe, regional differences in surgical choice may also not have been accurately captured due to the study geographic distribution.…”

Editorial Comment to Predicting factor analysis of postoperative complications after robot‐assisted radical cystectomy: Multicenter KORARC database study

“…ICUD is superior over ECUD in terms of reduced blood loss and blood transfusion rates, 2 further enhancing the advantages of RARC over open RC in this respect. Conceptually, ICUD, during which bowels are kept from drying, is expected to promote earlier recovery of bowel functions than ECUD.…”