Uretero‐enteric stricture outcomes: secondary analysis of a randomised controlled trial comparing open versus robot‐assisted radical cystectomy

Abstract

To analyse the risk of uretero-enteric anastomotic stricture in patients randomised to open (ORC) or robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion. Patients and MethodsWe included 118 patients randomised to RARC (n = 60) or ORC (n = 58) at a single, high-volume institution from March 2010 to April 2013. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher's exact test. ResultsIn all, 58 and 60 patients were randomised to RARC and ORC, respectively. We identified five strictures, all in the ORC group. In patients with ≥1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% confidence interval 1.5%, 17%). Of the five strictures, three were managed endoscopically while two required open revision. There was no evidence that perioperative Grade 3-5 complications were associated with development of a stricture (P = 1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (P = 0.15). ConclusionsIn this study at a high-volume centre, RARC with extracorporeal urinary diversion achieved excellent ureteric anastomotic outcomes. Purported increased risk of stricture is not a reason to avoid RARC. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed.

Systematic review comparing uretero-enteric stricture rates between open cystectomy with ileal conduit, robotic cystectomy with extra-corporeal ileal conduit and robotic cystectomy with intra corporeal ileal conduit formation

“…There is similar variability in the reporting of UES for ECUD procedures. No strictures were reported in a small study population of 56 patients [ 11 ]. An earlier study describes 12% stricture rate for ECUD procedures in a cohort of 103 patients [ 28 ].…”

“…Incidence of UES in open cystectomy is relatively low (3-10%) [9,10]. However, there is much heterogeneity in the literature regarding these results with stricture rates for robotic surgery, ranging from 0 to 25% in most recent studies [11][12][13].…”

“…It has been suggested that a robotic approach to cystectomy can increase the incidence of UES formation compared to open operations [12]. However, there is much heterogeneity in the literature regarding these results with stricture rates for robotic surgery, ranging from 0 to 25% in most recent studies [11][12][13]. Robotic surgery is in its infancy, and some studies have demonstrated a learning curve for surgeons.…”