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

Abstract

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.

Modified ileal conduit intracorporeally accomplished following laparoscopic radical cystectomy with enhanced recovery protocols: experience with 48 cases

“…Minor complications were more common, with only 6.3% of patients developing major complications. The complication rate, operative time, and time to oral intake in our study were not inferior to those reported in previous studies (11)(12)(13). ERAS protocols have gained significant attention in (18,19).…”

“…Of these, five patients died due to bladder cancer and nine patients died due to other diseases (organ failure, cerebral stroke, myocardial infarction, etc.). The two-year OS, CSS, and DFS were According to a limited number of studies, the time to flatus and oral intake were shorter in ICIC/ICUD than in extracorporeal approach (13)(14)(15). In our study, the time to flatus was two days and the time to liquid diet was three days.…”

“…et al(12) reported 90-day overall and major complication rates of intracorporeal urinary diversion of 81% and 19%, respectively. Kanno et al(13) compared the results of LRC with ICIC (72 cases) and extracorporeal ileal conduit (72 cases). The ICIC group had a longer operative time (676 vs. 616 min, P=0.002), fewer wound-related complications (6% vs. 18%, P=0.039), and a shorter time to regular oral food intake (4 vs. 5 days, P=0.014).…”

Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients

“…Post-surgery, each patient was re-evaluated on a 3-month basis for one year, 6-monthly for the second year and annually thereafter. Complications were reported according to the modified Clavien-Dindo classification system (5). Reservoir-related complications included obstructive or non-obstructive hydronephrosis, UIS, pyelonephritis, anastomotic leakage, metabolic acidosis and VUR.…”

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

“…Kanno et al compared the perioperative and oncological outcomes of pure laparoscopic ICUD-IC with extracorporeal ileal conduit urinary diversion after laparoscopic radical cystectomy for muscle-invasive bladder cancer. 4 Of 455 patients, they used matched pairs (72 vs 72), and they concluded that the laparoscopic ICUD-IC is safe, feasible with faster postoperative bowel recovery, decreased wound-related complication rates, and comparable postoperative complication rates and oncological outcomes compared with extracorporeal ileal conduit urinary diversion. However, the rationale for the benefit and utility of pure laparoscopic ICUD-IC in the robotic era needs to be debated.…”