Presentation Authors: JJ Zhang*, Kyle Ericson, Lewis Thomas, Alice Crane, Abhinav Khanna, Jacob Knorr, Michele Fascelli, Anna Zampini, Georges-Pascal Haber, Byron Lee, Cleveland, OH
Introduction: Surgical approach in radical cystectomy includes open radical cystectomy (ORC) and robotic-assisted radical cystectomy (RARC) with either intracorporeal urinary diversion (ICUD) or extracorporeal urinary diversion (ECUD). Multi-institutional studies have compared ORC to RARC or ICUD to ECUD, but comparison of all three surgical options have not been published from a single institution. The objective is to compare intraoperative outcomes, perioperative outcomes, and complication rates between open, intracorporeal, and extracorporeal diversions at a single high-volume tertiary care center.
Methods: A retrospective review was conducted of 641 patients who underwent radical cystectomy with urinary diversion at a single high-volume hospital between 2011-2018. Intraoperative outcomes, perioperative outcomes, and 90-day major complications (Clavien-Dindo classification III-V) were compared between ORC, ICUD and ECUD. Statistical analyses were performed using Pearson's chi squared test for categorical variables and one-way ANOVA or Kruskal-Wallis for continuous variables with significance defined as p < 0.05.
Results: 641 patients underwent radical cystectomy with urinary diversion: 231 ORC, 185 ICUD, and 225 ECUD. Estimated mean operative time was highest for ECUD (437.4 min) compared to ICUD (409.7 min) and ORC (334.8 min), p < 0.0001. Median estimated blood loss (EBL) was significantly lower for ICUD (300cc) compared to ECUD (400cc) and ORC (750cc), p < 0.0001. Comparing postoperative outcomes, patients undergoing ICUD had shorter hospitalization compared to ICUD and open cystectomy (7.9 v 9.5 v. 10.5 days), p < 0.0001. Although there was no significant difference in rate of ileus by surgical approach, ICUD was significantly associated with lower TPN requirement rates (7.6%) compared to ECUD (12.0%) and ORC (19.5%), p=0.001. Comparing complication rates, ICUD was significantly associated with lower 90-day major complication rate compared to ECUD and ORC (14.6% v 26.2% v 27.3%, p=0.04). There was no significant difference in 90-day readmission between the three approaches.
Conclusions: In our large single-institution experience, robotic intracorporeal urinary diversion demonstrated benefits of lower EBL, shorter hospital stay, lower TPN requirements, and lower major complication rates compared to both robotic extracorporeal diversion and open radical cystectomy.