Ahmed A Hussein1, Ahmed S Elsayed1, Naif A Aldhaam1, Zhe Jing1, James O Peabody2, Carl J Wijburg3, Andrew Wagner4, Abdullah Erdem Canda5, Mohammad Shamim Khan6, Douglas Scherr7, Francis Schanne8, Thomas J Maatman9, Eric Kim10, Alexandre Mottrie11, Ahmed Aboumohamed12, Franco Gaboardi13, Giovannalberto Pini13, Jihad Kaouk14, Bertram Yuh15, Koon-Ho Rha16, Ashok Hemal17, Joan Palou Redorta18, Ketan Badani19, Matthias Saar20, Michael Stockle20, Lee Richstone21, Morgan Roupret22, Derya Balbay23, Prokar Dasgupta6, Mani Menon2, Khurshid A Guru1. 1. Roswell Park Cancer Institute, Buffalo, NY, USA. 2. Henry Ford Health System, Detroit, MI, USA. 3. Rijnstate Hospital, Arnhem, The Netherlands. 4. Beth Israel Deaconess Medical Center, Boston, MA, USA. 5. Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey. 6. Guy's Hospital and King's College London School of Medicine, London, UK. 7. Weill Cornell Medical Center, New York, NY, USA. 8. Urological Surgical Associates of Delaware, Wilmington, DE, USA. 9. Metro Health Hospital, Michigan State University, East Lansing, MI, USA. 10. Washington University, St. Louis, MO, USA. 11. Onze-Lieve-Vrouw Ziekenhuis, Aalast, Belgium. 12. Montefiore Medical Center, The Albert Einstein College of Medicine, New York, NY, USA. 13. San Raffaele Turro Hospital, Milan, Italy. 14. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 15. City of Hope and Beckman Research Institute, Duarte, CA, USA. 16. Department of Urology, Yonsei University Health System Severance Hospital, Seoul, Korea. 17. Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. 18. Fundacio Puigvert, Barcelona, Spain. 19. Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA. 20. University of the Saarland, Homburg Saar, Germany. 21. The Arthur Smith Institute for Urology, New Hyde Park, NY, USA. 22. Pitie Salpetriere Academic Hospital, Sorbonne University, Paris, France. 23. Koç University Hospital, Istanbul, Turkey.
Abstract
OBJECTIVE: To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC). PATIENTS AND METHODS: We retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90-day high-grade complications (Clavien-Dindo Classification Grade ≥III), and 90-day readmissions after RARC. RESULTS: Utilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high-grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and receiving a neobladder were associated with longer operating times. Shorter operating time was associated with male gender, older age, ICUD, and centres with a larger annual average RC volume. Longer intensive care unit stay was associated with 90-day high-grade complications. Higher CCI score, prior radiation therapy, neoadjuvant chemotherapy, and ICUD were associated with a higher risk of 90-day readmissions. CONCLUSIONS: Utilisation of ICUD has increased over the past decade. ICUD was associated with more overall complications and readmissions compared to ECUD, but not high-grade complications.
OBJECTIVE: To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC). PATIENTS AND METHODS: We retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90-day high-grade complications (Clavien-Dindo Classification Grade ≥III), and 90-day readmissions after RARC. RESULTS: Utilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high-grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and receiving a neobladder were associated with longer operating times. Shorter operating time was associated with male gender, older age, ICUD, and centres with a larger annual average RC volume. Longer intensive care unit stay was associated with 90-day high-grade complications. Higher CCI score, prior radiation therapy, neoadjuvant chemotherapy, and ICUD were associated with a higher risk of 90-day readmissions. CONCLUSIONS: Utilisation of ICUD has increased over the past decade. ICUD was associated with more overall complications and readmissions compared to ECUD, but not high-grade complications.
Authors: Paola I Ornaghi; Luca Afferi; Alessandro Antonelli; Maria A Cerruto; Livio Mordasini; Agostino Mattei; Philipp Baumeister; Giancarlo Marra; Wojciech Krajewski; Andrea Mari; Francesco Soria; Benjamin Pradere; Evanguelos Xylinas; Alessandro Tafuri; Marco Moschini Journal: Arab J Urol Date: 2020-11-02
Authors: Carl J Wijburg; Gerjon Hannink; Charlotte T J Michels; Philip C Weijerman; Rami Issa; Andrea Tay; Karel Decaestecker; Peter Wiklund; Abolfazl Hosseini; Ashwin Sridhar; John Kelly; Frederiek d'Hondt; Alexandre Mottrie; Sjoerd Klaver; Sebastian Edeling; Paolo Dell'Oglio; Francesco Montorsi; Maroeska M Rovers; J Alfred Witjes Journal: Eur Urol Open Sci Date: 2022-04-02
Authors: Satoshi Katayama; Keiichiro Mori; Benjamin Pradere; Hadi Mostafaei; Victor M Schuettfort; Fahad Quhal; Reza Sari Motlagh; Ekaterina Laukhtina; Marco Moschini; Nico C Grossmann; Yasutomo Nasu; Shahrokh F Shariat; Harun Fajkovic Journal: Int J Clin Oncol Date: 2021-06-19 Impact factor: 3.402