Intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy: evidence from a systematic review and pooled analysis of observational studies

Feng, Dechao; Tang, Yin; Yang, Yubo; Han, Ping; Wei, Wuran

doi:10.23736/s0393-2249.20.03829-1

Cited by 12 publications

(6 citation statements)

References 47 publications

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“…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.…”

Section: Intracorporeal Urinary Diversionsupporting

confidence: 57%

Update on robotic cystectomy

Grauer

Wiklund

2021

Current Opinion in Urology

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Purpose of reviewThis article aims to discuss recently published (2019–2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics.Recent findingsRARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming.SummaryORC is the current ‘gold standard’ management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed—informing further adoption of the technique.

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Section: Intracorporeal Urinary Diversionsupporting

confidence: 57%

Update on robotic cystectomy

Grauer

Wiklund

2021

Current Opinion in Urology

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“…As is known to all, ORC with extended pelvic lymph node dissection has been gold standard for patients with muscle-invasive and high-risk non-muscle-invasive bladder cancer for decades ( 3 ). However, conspicuous complications and higher mortality leave much to be desired ( 4 ). Although our previous studies indicated that minimally invasive approaches, scilicet RARC and laparoscopic RC (LRC), presented improved perioperative outcomes and comparable pathological and oncologic outcomes at the cost of longer operative time when compared to ORC ( 26 , 27 ), on no account can we ignore the fact that many of the perioperative complications following RC might derive from the reconstructive part of the procedure, and overwhelming majority of studies included in our meta-analysis were insufficient information of stomal-related complication, such as PH whose incidence was not low (PR: 23%; 95% CI: 17–29%).…”

Section: Discussionmentioning

confidence: 99%

“…Radical cystectomy (RC) and ileal conduit (IC) diversion has currently been regarded as the mainstream treatment of muscle-invasive and high-risk non-muscle-invasive bladder cancer ( 3 ). However, this approach is usually associated with noteworthy complications and higher mortality concerning the complexity of the operation involving urinary and intestinal systems ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…It is conceivable that the urinary diversion (UD) contributes to great risk of postoperative morbidity and complications other than cystectomy itself ( 4 , 5 ). Among the long-term complications reported, parastomal hernia (PH) is a frequent sequela resulting in cosmetic and functional concerns, and surgical repair is required in some cases, such as intestinal incarceration and strangulation ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis

Feng¹,

Wang²,

Yang³

et al. 2021

Transl Cancer Res TCR

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Background: Our aim is to report the incidence and risk factors of parastomal hernia (PH) after radical cystectomy (RC) and ileal conduit (IC) diversion with a cumulative analysis.Methods: Various databases, including PubMed, the Cochrane Library, Embase and Web of Science, were retrieved electronically and manually to identify eligible studies from inception to August 20, 2020. Two reviewers independently searched the above databases and selected the studies using prespecified standardized criteria. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in the included studies, and the data was completed by STATA version 14.2.Results: Fifteen studies were included in the final analysis. A pooled analysis of eight studies representing 1,878 patients reported the incidence of overall radiographic PH was 23% (95% CI: 17-29%). The 1-year PH incidence rate and 2-year incidence rate of RC and IC were 14% (95% CI: 6-22%) and 26% (95% CI: 14-38%), respectively. A pooled analysis of nine studies reported the incidence of clinically evident PH was 15% (95% CI: 10-19%). PH-related symptoms were reported in six studies, and the pooled result was 29% (95% CI: 24-33%), and a pooled analysis of ten studies showed that 20% (95% CI: 11-28%) of patients required surgical repair. However, it's noteworthy that among symptomatic PH patients undergoing surgical repair, the pooled analysis of five studies showed that up to 26% (95% CI: 16-36%) of patients suffered PH recurrence. The most frequent risk factor was body mass index (BMI). Patients with BMI ≥22.9 kg/m 2 experienced 2.92-fold higher risk of PH than their counterparts [hazard ratio (HR): 2.92; 95% CI: 1.65-5.19].Conclusions: Our findings indicated that the PH incidence rate after RC and IC was significantly higher in radiographic evaluation than that of clinical examination, and the recurrence of repairment is considerable for patients requiring reconstruction.

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“…Ahmadi et al [18] looked at UEAS rates in intracorporeal diversions with and without the use of indocyanine green (ICG) for perfusion evaluation of the distal ureter. What they found was that not only was there a much greater amount of distal ureter excised before anastomosis (> 5 cm in some cases) but that the ICG group had a 0% stricture formation at 12 months of follow up compared to the 10.6% per patient rate in the non-ICG group.…”

Section: Ureteroenteric Stricture Formationmentioning

confidence: 99%

Review of intracorporeal and extracorporeal continent urinary diversion - where do we stand in 2021?

Balzano¹,

Chan²

2021

Mini-invasive Surg

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Robot-assisted radical cystectomy has become widely accepted as a safe and minimally invasive procedure for the treatment of bladder cancer. The urinary diversion continues to be performed completely intracorporeally or extracorporeally. Over the past decade, there has been an increasing number of continent diversions being performed intracorporeally. We evaluated the most recent literature regarding intraoperative metrics and outcomes that compare the intracorporeal and extracorporeal approaches.

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Intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy: evidence from a systematic review and pooled analysis of observational studies

Cited by 12 publications

References 47 publications

Update on robotic cystectomy

Update on robotic cystectomy

Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis

Review of intracorporeal and extracorporeal continent urinary diversion - where do we stand in 2021?

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