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Contemporary outcomes of patients undergoing robotic-assisted radical cystectomy:A comparative analysis between intracorporeal ileal conduit and neobladder urinary diversions

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Asian Journal of Urology 2023年第4期10卷 446-452页

作者： Jordan M.Rich Shivaram Cumarasamy Daniel Ranti Etienne Lavallee Kyrollis Attalla John P.Sfakianos Nikhil Waingankar Peter N.Wiklund Reza Mehrazin Department of Urology Icahn School of Medicine at Mount SinaiNew YorkNYUSA Department of Urology Karolinska University HospitalSolnaSweden

Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage

关键词： Robotic Radical cystectomy Intracorporeal ileal conduit Neobladder Urinary diversion Oncologic outcome

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A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal ileal conduit after Laparoscopic Radical Cystectomy from a Single Center

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Chinese Medical Journal 2018年第7期131卷 784-789页

作者： Ming-Shuai Wang Qing-Bao He Fei-Ya Yang Hao Ping Nian-Zeng Xing Department of Urology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

Background： Robot-assisted/laparoscopic intracorporeal ileal conduit （ICIC） has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit （ECIC） and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy （LRC） with ICIC and ECIC. Methods： From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient＇s characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed. Results： LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients＇ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group （3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002）. The complications rates did not show significant difference between the two groups within the first 90 days postoperatively （P = 0.538）. Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1＋. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months （60% vs. 62%, P = 0.857） between the ECIC and ICIC groups. Conclusions： ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.

关键词： ileal conduit Laparoscopy Urinary Bladder Cancer

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An improved ileal conduit surgery for bladder cancer with fewer complications

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Cancer Communications 2019年第1期39卷 178-187页

作者： Zhiyong Li Zhuowei Liu Kai Yao Zike Qin Hui Han Yonghong Li Pei Dong Yunlin Ye Yanjun Wang Zhiming Wu Zhiling Zhang Fangjian Zhou Department of Urology State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterNo.651 Dongfeng Road EastGuangzhou 510060GuangdongP.R.China

Background:Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer.Although this approach prolongs patient survival remarkably,there are postoperative complications associated with urinary diversion.This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma-and ureteroileal anastomo-sis-related complications,as compared with conventional ileal conduit urinary diversion.Methods:We retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1,2000 and June 30,2016.ileal conduit was created by the conventional or a modified technique.The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test.Multivari-able logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma-and ureteroileal anastomosis-related complications in the two groups.Results:145 and 100 patients underwent the modified and conventional ileal conduit surgery,respectively.The two groups were comparable with regard to clinicopathologic features.The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(0.7%vs.17.0%,Pileal conduit group,but were seen in 13(13.0%)patients in the conventional ileal conduit group.The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(4.8%vs.15.0%,P=0.001).In multivariable analyses,the modified ileal conduit group was significantly less likely to develop stoma-(odds ratio[OR]=0.024,95%confidence interval[CI]0.003-0.23

关键词： Bladder cancer Cystectomy Urinary diversion ileal conduit Complication Surgical technique

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Totally intracorporeal robot-assisted urinary diversion for bladder cancer(Part 1).Review and detailed characterization of ileal conduit and modified Indiana pouch

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Asian Journal of Urology 2021年第1期8卷 50-62页

作者： Hugo Otaola-Arca Rafael Coelho Vipul R.Patel Marcelo Orvieto Department of Urology Clı´nica AlemanaSantiagoChile School of Medicine Clı´nica Alemana-Universidad del DesarrolloSantiagoChile Universidade de Sa˜o Paulo Instituto do Caˆncer do Estado de Sa˜o Paulo Brazil Department of Urology AdventHealth Global Robotics InstituteCelebrationFLUnited States

Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images Methods:A non-systematic review of the literature with the keywords“bladder cancer”,“cutaneous urinary diversion”,and“radical cystectomy”was performed.Results:Twenty-four studies of intracorporeal ileal conduit(ICIC)and two of intracorporeal Indiana pouch(ICIP)were included in the analysis.Regarding ICIC,the patients’age ranged from 60 to 76 years.The operative time to perform a urinary diversion ranged from 60 to 133 min.The total estimated blood loss ranged from 200 to 1117 mL.The rate of positive surgical margins ranged from 0%to 14.3%.Early minor and major complication rates ranged from 0%to 71.4%and from 0%to 53.4%,respectively.Late minor and major complication rates ranged from 0%to 66%and from 0%to 32%,respectively.Totally ICIP data are limited to one case report and one clinical series.Conclusion:The most frequent type of CUD is ICIC.Randomized studies comparing the performance of the different types of CUD,the performance in an intra-or extracorporeal manner,or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature.To this day,there are not enough quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images for each technique.

关键词： Bladder cancer ileal conduit Indiana pouch Intracorporeal urinary diversion Robot-assisted radical cystectomy Surgical technique

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