Abstract
Background
The number of facilities adapting intracorporeal urinary diversion (ICUD) using robots instead of extracorporeal urinary diversion (ECUD) is increasing, but the clinical evidence is limited.
Methods
We retrospectively analyzed 26 consecutive patients who underwent ICUD with an ileal conduit following robot-assisted radical cystectomy (RARC) between 2018 and 2020 (RARC + ICUD group), and compared them with 26 consecutive patients who underwent ECUD with an ileal conduit following laparoscopic radical cystectomy (LRC) between 2012 and 2019 (LRC + ECUD group) at Yokohama City University.
Results
In both groups, the patient background was similar except for age and neoadjuvant chemotherapy. In the RARC + ICUD group vs. the LRC + ECUD group, the median total operation time was 516 min vs. 532.5 min (p = 0.217), the time to cystectomy was 163 min vs. 194.5 min (p = 0.007), and the time of urinary diversion with an ileal conduit was 161 min vs. 201.5 min (p < 0.001). The postoperative maximum value of C-reactive protein was 6.98 mg/L vs. 12.46 mg/L (p = 0.001). The median number of days to oral intake was 3 days vs. 5 days (p = 0.003). The median length of hospital stay was 17 days vs. 32 days (p < 0.001). The postoperative complication rate (within 90 days) was 23.1% vs. 42.3% (p = 0.237). Clavien-Dindo classification ≥ 3 was noted in 1 vs. 4 patients (p = 0.350). The median number of dissected lymph nodes was 20 vs. 15 (p = 0.008).
Conclusions
RARC + ICUD was superior to LRC + ECUD in terms of time to cystectomy and ileal conduit urinary diversion, invasiveness, and lymph node dissection. We consider ICUD with an ileal conduit following RARC to be the more advantageous procedure.
The perioperative outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion compared with laparoscopic radical cystectomy with extracorporeal urinary diversion at a single institution.
