Robot-Assisted Radical Cystectomy with Total Intracorporeal Urinary Diversion: Comparative Analysis with Extracorporeal Urinary Diversion

Pyun, Jong Hyun; Kim, Hyung Keun; Cho, Seok; Kang, Sung Gu; Cheon, Jun; Lee, Jeong Gu; Kim, Je Jong; Kang, Seok Ho

doi:10.1089/lap.2015.0543

Cited by 36 publications

(21 citation statements)

References 25 publications

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“…[ 10 ] Pyun et al . [ 11 ] compared the perioperative outcomes of intracorporeal urinary diversion with those of extracorporeal urinary diversion following robot-assisted radical cystectomy, indicating that the time to flatus is also comparable (72.1 h vs. 71.9 h, P = 0.979). Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programs can reduce surgical morbidity and length of stay.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center

Wang

Yang

et al. 2018

Chinese Medical Journal

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Background:Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.Methods:From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.Results:LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients’ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan–Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.Conclusions:ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center

Wang

Yang

et al. 2018

Chinese Medical Journal

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“…This may be ascribed to the fact that the surgical stress response associated with extra-corporeal diversion is similar to the surgical stress response caused by an open approach [ 21 ]. Two studies [ 44 , 45 ] comparing postoperative complications in patients undergoing ECUD and intra-corporeal urinary diversion (ICUD) found a trend in favour of ICUD. Ahmed et al [ 44 ] compared 768 patients who had ECUD to 167 patients who had ICUD and found no statistically significant difference in complication rates within 30 days (43% in the ECUD group vs 35% in the ICUD group; p = 0.07).…”

Section: Discussionmentioning

confidence: 99%

Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs

et al. 2017

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BackgroundRadical cystectomy is associated with high rates of perioperative morbidity. Robotic-assisted radical cystectomy (RARC) is widely used today despite limited evidence for clinical superiority. The aim of this review was to evaluate the effect of RARC compared to open radical cystectomy (ORC) on complications and secondary on length of stay, time back to work and health-related quality of life (HRQoL).MethodsThe databases PubMed, The Cochrane Library, Embase and CINAHL were searched. A systematic review according to the PRISMA guidelines and cumulative analysis was conducted. Randomized controlled trials (RCTs) that examined RARC compared to ORC were included in this review. We assessed the quality of evidence using the Cochrane Collaboration’s ‘Risk of bias’ tool and Grading of Recommendations Assessment, Development and Evaluation approach. Data were extracted and analysed.ResultsThe search retrieved 273 articles. Four RCTs were included involving overall 239 patients. The quality of the evidence was of low to moderate quality. There was no significant difference between RARC and ORC in the number of patients developing complications within 30 or 90 days postoperatively or in overall grade 3–5 complications within 30 or 90 days postoperatively. Types of complications differed between the RARC and the ORC group. Likewise, length of stay and HRQoL at 3 and 6 months did not differ.ConclusionOur review presents evidence for RARC not being superior to ORC regarding complications, LOS and HRQoL. High-quality studies with consistent registration of complications and patient-related outcomes are warranted.Systematic review registrationPROSPERO CRD42016038232 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0547-y) contains supplementary material, which is available to authorized users.

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“…(Early period (2008–2012) and late period (2012–2017)). [ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 ] All the included studies may overlap and may also include periods of surgeons’ learning curve. The fact that in the late period, we see more “mature” studies, does not result in significant improvements in the perioperative or oncological outcomes.…”

Section: Complicationsmentioning

confidence: 99%

The current status of robot-assisted cystectomy

2018

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Robot-assistance is being increasingly used for radical cystectomy (RC). Fifteen years of surgical evolution might be considered a short period for a radical procedure to be established as the treatment of choice, but robot assisted radical cystectomy (RARC) is showing promising results when compared with the current gold standard, open RC (ORC). In this review, we describe the current status of RARC and continue the discussion on the on-going RARC versus ORC debate.

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Robot-Assisted Radical Cystectomy with Total Intracorporeal Urinary Diversion: Comparative Analysis with Extracorporeal Urinary Diversion

Abstract: From our experience, the results show that ICUD after RARC can be successful, with the benefits of decreased blood loss and lower transfusion and complication rates than ECUD. A larger series and long-term follow-up data will be necessary to support our results.

Cited by 36 publications

References 25 publications

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center

Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs

The current status of robot-assisted cystectomy

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