Analysis of Intracorporeal Compared with Extracorporeal Urinary Diversion After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
Por:
Ahmed, K, Khan, SA, Hayn, MH, Agarwal, PK, Badani, KK, Balbay, MD, 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
Publicada:
1 feb 2014
Resumen:
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. (C) 2013 Published by Elsevier B. V. on behalf of European Association of Urology.
Filiaciones:
Ahmed, K:
Kings Coll London, Guys Hosp, Dept Urol, MRC,Ctr Transplantat, London, England
Khan, SA:
Kings Coll London, Guys Hosp, Dept Urol, MRC,Ctr Transplantat, London, England
Hayn, MH:
Maine Med Ctr, Div Urol, Portland, ME 04102 USA
Agarwal, PK:
Henry Ford Hlth Syst, Detroit, MI USA
Badani, KK:
Columbia Univ, Med Ctr, New York, NY USA
Balbay, MD:
Mem Sisli Hosp, Istanbul, Turkey
Castle, EP:
Mayo Clin, Scottsdale, AZ USA
Dasgupta, P:
Kings Coll London, Guys Hosp, Dept Urol, MRC,Ctr Transplantat, London, England
Ghavamian, R:
Montefiore Med Ctr, Albert Einstein Coll Med, UN Hosp, Bronx, NY 10467 USA
Guru, KA:
Roswell Pk Canc Inst, Buffalo, NY 14225 USA
Hemal, AK:
Wake Forest Univ, Baptist Med Ctr, Salem, NC USA
Hollenbeck, BK:
Univ Michigan Hlth Syst, Ann Arbor, MI USA
Kibel, AS:
Washington Univ, Sch Med, St Louis, MO USA
Menon, M:
Henry Ford Hlth Syst, Detroit, MI USA
Mottrie, A:
Onze Lieve Vrouw Hosp, Aalst, Belgium
Nepple, K:
Washington Univ, Sch Med, St Louis, MO USA
Pattaras, JG:
Emory Univ, Sch Med, Atlanta, GA USA
Peabody, JO:
Henry Ford Hlth Syst, Detroit, MI USA
Poulakis, V:
Doctors Hosp Athens, Athens, Greece
Pruthi, RS:
Univ N Carolina, Chapel Hill, NC 27515 USA
Redorta, JP:
Fundacio Puigvert, Barcelona, Spain
Rha, KH:
Yonsei Univ Hlth Syst, Severance Hosp, Seoul, South Korea
Richstone, L:
Arthur Smith Inst Urol, New Hyde Pk, NY USA
Saar, M:
Univ Clin Saarland, Homburg, Germany
Scherr, DS:
Weill Cornell Med Coll, New York, NY USA
Siemer, S:
Univ Clin Saarland, Homburg, Germany
Stoeckle, M:
Univ Clin Saarland, Homburg, Germany
Wallen, EM:
Univ N Carolina, Chapel Hill, NC 27515 USA
Weizer, AZ:
Univ Michigan Hlth Syst, Ann Arbor, MI USA
Wiklund, P:
Karolinska Univ Hosp, Stockholm, Sweden
Wilson, T:
City Hope Natl Med Ctr, Duarte, CA USA
City Hope Natl Med Ctr, Beckman Res Inst, Duarte, CA 91010 USA
Woods, M:
Loyola Univ, Med Ctr, Maywood, IL 60153 USA
Khan, MS:
Kings Coll London, Guys Hosp, Dept Urol, MRC,Ctr Transplantat, London, England
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