Robot-assisted radical cystectomy with intracorporeal urinary diversion decreases postoperative complications only in highly comorbid patients: findings that rely on a standardized methodology recommended by the European Association of Urology Guidelines

Mazzone, Elio; D’Hondt, Frederiek; Beato, Sílvia; Andraș, Iulia; Lambert, E. Warren; Vollemaere, Jonathan; Moschovas, Marcio Covas; Groote, Ruben De; Naeyer, Geert De; Schatteman, Peter; Mottrie, Alexandre; Dell’Oglio, Paolo

doi:10.1007/s00345-020-03237-5

Cited by 32 publications

(32 citation statements)

References 23 publications

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“…We identified 298 studies in PubMed, 1659 studies in Web of Science, and 31 studies in Scopus from the initial search; 2 additional studies were added after the latest search. After removing 219 duplicate articles, we screened 1771 titles and abstracts, reviewed 145 full-text articles, which led to the identification of 12 articles comprising 3067 patients that met our inclusion/exclusion criteria [18,[20][21][22][23][24][25][26][27][28][29][30]. Five articles were excluded because of an overlap in the recruitment period at the same institution (Fig.…”

Section: Search Resultsmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Search Resultsmentioning

confidence: 99%

“…Blood transfusion has been shown to be significantly associated with worse perioperative morbidity and survival [38][39][40]. It was also noteworthy that ICUD patients with high ageadjusted Charlson Comorbidity Index had a lower risk of complications relative to ECUD patients [23]. One possible Fig.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…In comparison, our 90-d severe complication rate was 27% and our 30-d overall complication rate was 73% (data not shown). Mazzone et al [21] did not report the rate of major or overall complications, but a 30-d rate of CDC grade ≥2 complications of 38%. The most likely explanation for these differences is related to the definition of a complication.…”

Section: Discussionmentioning

confidence: 99%

“…Quantification of morbidity has been diverse, and therefore the EAU has proposed quality criteria for standardised reporting to make comparison across series easier. To the best of our knowledge, only a few other studies have fulfilled these criteria after RC [20] , [21] , [22] . In accordance with the results of the PURE-01 trial, we found that a major complication occurred in approximately one-third of all patients undergoing RC.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Days Alive and Out of Hospital Within 90 Days Following Radical Cystectomy for Bladder Cancer

Maibom

Røder

Poulsen

et al. 2021

European Urology Open Science

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Background Morbidity after radical cystectomy (RC) is usually quantified in terms of rates of complications, mortality, reoperations, and readmissions, and length of stay (LOS). The overall burden following RC within the first 90 d following RC may be better described using days alive and out of hospital (DAOH), which is a validated, patient-centred proxy for both morbidity and mortality. Objective To report short-term morbidity, LOS, and DAOH within 90 d after RC and risk factors associated with these parameters. Design, setting and participants The study included 729 patients undergoing RC for bladder cancer at a single academic centre from 2009 to 2019. Data were retrieved from national electronic medical charts. Outcome measurements and statistical analysis Multivariate analysis was used to investigate variables associated with a major complication, LOS >7 d, and DAOH <80 d. Results and limitations The 90-d complication rate was 80%, including major complications in 37% of cases. Median LOS was 7 d (interquartile range (IQR) 6–9) and median DAOH was 80 d (IQR 71–83) days. Body mass index and the Charlson comorbidity index (CCI) predicted major complications. CCI predicted LOS >7 d and DAOH <80 d. Conclusions RC was associated with significant short-term morbidity and DAOH was a good marker for cumulative morbidity after RC. We propose that DAOH should be a standard supplement for reporting surgical outcomes following RC for bladder cancer, which may facilitate better comparison of outcomes across treating institutions. Patient summary We studied complications after surgical removal of the bladder for bladder cancer. We assessed a novel patient-centred tool that more accurately describes the total burden of complications after surgery than traditional models. We found that patients with a high body mass index and coexisting chronic diseases had a higher risk of a complicated surgical course.

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“…Radical cystectomy is the gold standard for the treatment of muscle-invasive bladder cancer and high-risk nonmuscle invasive disease. Despite the widespread application and the increasing surgical experience with robot-assisted radical cystectomy (RARC), Clavien − Dindo ≥ 2 complications have been reported in 35-40% of the patients treated with RARC [ 1 ]. Ischemic complications can occur due to the increased intra-abdominal pressure associated with pneumoperitoneum applied during laparoscopic and robotic procedures, which can impair the splanchnic perfusion.…”

Section: Introductionmentioning

confidence: 99%

First Report of Two Cases of Acute Gastric Ischemia after Robot-Assisted Radical Cystectomy

Grivas

Horsch

Wit

et al. 2021

Case Reports in Urology

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Gastrointestinal ischemia is rare after small pelvis surgery. Minimal invasive robotic surgery requires adaptation of the surgical approach for cystectomy and derivation construction such as the use of pneumoperitoneum and Trendelenburg positioning of the patient. Two cases with gastric ischemic complications after robot-assisted radical cystectomy are described. The first case was a 68-year-old female who had prolonged gastroparalysis and blood in a replaced gastric tube at day 10 after robotic cystectomy and Bricker urinary derivation. Gastroscopy revealed ischemia of gastric and proximal duodenal mucosa while computed tomography showed multiple calcifications and thrombi in the coeliac trunk branches and splenic infarcts. The stenosis of the origin of the mesenteric superior artery was stented via an endovascular procedure, and the patient recovered with normal gastroscopy 1 month postoperatively. The second case was a 73-year-old male who developed abdominal pain and fever 5 days after robotic cystectomy and Bricker. On abdominal computed tomography imaging, subcutaneous emphysema, intra-abdominal air, and calcification at the origin of the coeliac trunk were found. At laparotomy 5 days after the cystectomy, a 3 cm hole in the fundus of the stomach was found which was removed with the major stomach curvature. Gastroscopy 5 days after hemigastrectomy revealed no remnant ischemia. The prolonged pneumoperitoneum during robotic cystectomy, the deep Trendelenburg position, and the preoperatively impaired vascular system can be the reasons of our first two cases of gastric ischemia. This rare complication should be kept in mind in patients with symptoms of gastric ischemia since it can result in gastric perforation.

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Robot-assisted radical cystectomy with intracorporeal urinary diversion decreases postoperative complications only in highly comorbid patients: findings that rely on a standardized methodology recommended by the European Association of Urology Guidelines

Cited by 32 publications

References 23 publications

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

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

Morbidity and Days Alive and Out of Hospital Within 90 Days Following Radical Cystectomy for Bladder Cancer

First Report of Two Cases of Acute Gastric Ischemia after Robot-Assisted Radical Cystectomy

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