Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy

Results from the international robotic cystectomy consortium

Kamran Ahmed, Shahid A. Khan, Matthew H. Hayn, Piyush K. Agarwal, Ketan K. Badani, M. Derya Balbay, Erik P. Castle, Prokar Dasgupta, Reza Ghavamian, Khurshid A. Guru, Ashok K. Hemal, Brent K. Hollenbeck, Adam S. Kibel, Mani Menon, Alex Mottrie, Kenneth Nepple, John G. Pattaras, James O. Peabody, Vassilis Poulakis, Raj S. Pruthi & 13 others Joan Palou Redorta, Koon Ho Rha, Lee Richstone, Matthias Saar, Douglas S. Scherr, Stefan Siemer, Michael Stoeckle, Eric M. Wallen, Alon Z. Weizer, Peter Wiklund, Timothy Wilson, Michael Woods, Muhammad Shamim Khan

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

Background Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance. Objective To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC). Design, setting, and participants We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011. Intervention All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally. Outcome measurements and statistical analysis Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables. Results and limitations Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p = 0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p = 0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p = 0.02). Being a retrospective study was the main limitation. Conclusions Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.

Original languageEnglish (US)
Pages (from-to)340-347
Number of pages8
JournalEuropean Urology
Volume65
Issue number2
DOIs
StatePublished - Feb 2014

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Urinary Diversion
Cystectomy
Robotics
Lymph Node Excision
Nonparametric Statistics
Statistical Data Interpretation

Keywords

  • Complications
  • Extracorporeal urinary diversion
  • Intracorporeal urinary diversion
  • Outcomes
  • Robot-assisted
  • Robotic radical cystectomy
  • Urinary diversion

ASJC Scopus subject areas

  • Urology

Cite this

Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy : Results from the international robotic cystectomy consortium. / Ahmed, Kamran; Khan, Shahid A.; Hayn, Matthew H.; Agarwal, Piyush K.; Badani, Ketan K.; Derya Balbay, M.; Castle, Erik P.; Dasgupta, Prokar; Ghavamian, Reza; Guru, Khurshid A.; Hemal, Ashok K.; Hollenbeck, Brent K.; Kibel, Adam S.; Menon, Mani; Mottrie, Alex; Nepple, Kenneth; Pattaras, John G.; Peabody, James O.; Poulakis, Vassilis; Pruthi, Raj S.; Redorta, Joan Palou; Rha, Koon Ho; Richstone, Lee; Saar, Matthias; Scherr, Douglas S.; Siemer, Stefan; Stoeckle, Michael; Wallen, Eric M.; Weizer, Alon Z.; Wiklund, Peter; Wilson, Timothy; Woods, Michael; Khan, Muhammad Shamim.

In: European Urology, Vol. 65, No. 2, 02.2014, p. 340-347.

Research output: Contribution to journalArticle

Ahmed, K, Khan, SA, Hayn, MH, Agarwal, PK, Badani, KK, Derya Balbay, M, Castle, EP, Dasgupta, P, Ghavamian, R, Guru, KA, Hemal, AK, Hollenbeck, BK, Kibel, AS, Menon, M, Mottrie, A, Nepple, K, Pattaras, JG, Peabody, JO, Poulakis, V, Pruthi, RS, Redorta, JP, Rha, KH, Richstone, L, Saar, M, Scherr, DS, Siemer, S, Stoeckle, M, Wallen, EM, Weizer, AZ, Wiklund, P, Wilson, T, Woods, M & Khan, MS 2014, 'Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium', European Urology, vol. 65, no. 2, pp. 340-347. https://doi.org/10.1016/j.eururo.2013.09.042
Ahmed, Kamran ; Khan, Shahid A. ; Hayn, Matthew H. ; Agarwal, Piyush K. ; Badani, Ketan K. ; Derya Balbay, M. ; Castle, Erik P. ; Dasgupta, Prokar ; Ghavamian, Reza ; Guru, Khurshid A. ; Hemal, Ashok K. ; Hollenbeck, Brent K. ; Kibel, Adam S. ; Menon, Mani ; Mottrie, Alex ; Nepple, Kenneth ; Pattaras, John G. ; Peabody, James O. ; Poulakis, Vassilis ; Pruthi, Raj S. ; Redorta, Joan Palou ; Rha, Koon Ho ; Richstone, Lee ; Saar, Matthias ; Scherr, Douglas S. ; Siemer, Stefan ; Stoeckle, Michael ; Wallen, Eric M. ; Weizer, Alon Z. ; Wiklund, Peter ; Wilson, Timothy ; Woods, Michael ; Khan, Muhammad Shamim. / Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy : Results from the international robotic cystectomy consortium. In: European Urology. 2014 ; Vol. 65, No. 2. pp. 340-347.
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abstract = "Background Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance. Objective To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC). Design, setting, and participants We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011. Intervention All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally. Outcome measurements and statistical analysis Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables. Results and limitations Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p = 0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41{\%} vs 49{\%}, p = 0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32{\%}) (odds ratio: 0.68; 95{\%} confidence interval, 0.50-0.94; p = 0.02). Being a retrospective study was the main limitation. Conclusions Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.",
keywords = "Complications, Extracorporeal urinary diversion, Intracorporeal urinary diversion, Outcomes, Robot-assisted, Robotic radical cystectomy, Urinary diversion",
author = "Kamran Ahmed and Khan, {Shahid A.} and Hayn, {Matthew H.} and Agarwal, {Piyush K.} and Badani, {Ketan K.} and {Derya Balbay}, M. and Castle, {Erik P.} and Prokar Dasgupta and Reza Ghavamian and Guru, {Khurshid A.} and Hemal, {Ashok K.} and Hollenbeck, {Brent K.} and Kibel, {Adam S.} and Mani Menon and Alex Mottrie and Kenneth Nepple and Pattaras, {John G.} and Peabody, {James O.} and Vassilis Poulakis and Pruthi, {Raj S.} and Redorta, {Joan Palou} and Rha, {Koon Ho} and Lee Richstone and Matthias Saar and Scherr, {Douglas S.} and Stefan Siemer and Michael Stoeckle and Wallen, {Eric M.} and Weizer, {Alon Z.} and Peter Wiklund and Timothy Wilson and Michael Woods and Khan, {Muhammad Shamim}",
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TY - JOUR

T1 - Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy

T2 - Results from the international robotic cystectomy consortium

AU - Ahmed, Kamran

AU - Khan, Shahid A.

AU - Hayn, Matthew H.

AU - Agarwal, Piyush K.

AU - Badani, Ketan K.

AU - Derya Balbay, M.

AU - Castle, Erik P.

AU - Dasgupta, Prokar

AU - Ghavamian, Reza

AU - Guru, Khurshid A.

AU - Hemal, Ashok K.

AU - Hollenbeck, Brent K.

AU - Kibel, Adam S.

AU - Menon, Mani

AU - Mottrie, Alex

AU - Nepple, Kenneth

AU - Pattaras, John G.

AU - Peabody, James O.

AU - Poulakis, Vassilis

AU - Pruthi, Raj S.

AU - Redorta, Joan Palou

AU - Rha, Koon Ho

AU - Richstone, Lee

AU - Saar, Matthias

AU - Scherr, Douglas S.

AU - Siemer, Stefan

AU - Stoeckle, Michael

AU - Wallen, Eric M.

AU - Weizer, Alon Z.

AU - Wiklund, Peter

AU - Wilson, Timothy

AU - Woods, Michael

AU - Khan, Muhammad Shamim

PY - 2014/2

Y1 - 2014/2

N2 - Background Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance. Objective To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC). Design, setting, and participants We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011. Intervention All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally. Outcome measurements and statistical analysis Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables. Results and limitations Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p = 0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p = 0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p = 0.02). Being a retrospective study was the main limitation. Conclusions Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.

AB - Background Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance. Objective To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC). Design, setting, and participants We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011. Intervention All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally. Outcome measurements and statistical analysis Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables. Results and limitations Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p = 0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p = 0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p = 0.02). Being a retrospective study was the main limitation. Conclusions Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.

KW - Complications

KW - Extracorporeal urinary diversion

KW - Intracorporeal urinary diversion

KW - Outcomes

KW - Robot-assisted

KW - Robotic radical cystectomy

KW - Urinary diversion

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