Introduction: Available studies comparing robot-assisted radical cystectomy (RARC) with intracorporeal (ICUD) vs. extracorporeal (ECUD) urinary diversion did not rely on a standardized methodology to report complications and did not assess whether specific subgroups of patients might benefit of one approach relative to the other
Methods: 267 patients treated with RARC with ICUD or ECUD at a single European centre were assessed. Complications were collected according to the standardized methodology proposed by the European Association of Urology. Multivariable logistic regression models (MVA) assessed the impact of the type of approach (ICUD vs. ECUD) on intraoperative complications, prolonged length of stay (LOS), 30-day Clavien Dindo (CD)=2 complications and readmission rate, after adjusting for confounders. To test the hypothesis that the impact of the approach was different in specific patient subgroups, interaction tests were performed. Lowess graphically depicted the probability of CD=2 after ICUD or ECUD according to patient baseline characteristics.
Results: Overall, 24 intraoperative complications occurred in 267 patients. The median LOS and readmission rate were 11 vs. 13 (p=0.02) and 24 vs. 22% (p=0.7) in ICUD vs. ECUD, respectively. Overall, 227 postoperative complications occurred in 267 patients. The most common were gastrointestinal (26.2%), infectious (23.5%), genitourinary (7.5%), neurological (6.7%) and cardiac (6.7%) complications. The overall rate of CD=2 was 35.2 and 42.9% in patients with ICUD vs. ECUD, respectively (p=0.2). At MVA, the type of approach was not an independent predictor of intraoperative complications, prolonged LOS, readmission and CD=2 (all p>0.4). Age-adjusted Charlson comorbidity index (ACCI) was associated with an increased risk of CD=2 (OR: 1.2, p=0.006). We identified a statistically significant interaction term between baseline ACCI and type of approach (p=0.04), where patients with ICUD had lower risk of CD=2 relative to those with ECUD with increasing ACCI (Fig. 1).
Conclusions: Relying on a standardized methodology to report complications, we observed that highly comorbid patients who undergo ICUD have lower risk of postoperative complications relative to those patients who received ECUD. Source of