title: Ureteroenteric anastomotic strictures after radical cystectomy-does operative approach matter?
abstract: OBJECTIVE
  Robot-assisted laparoscopic radical cystectomy has been increasingly used to decrease the morbidity of radical cystectomy. However, whether it truly lowers the complication rate compared to open radical cystectomy is not well established. We examined the benign ureteroenteric anastomotic stricture rates of open and robot-assisted laparoscopic radical cystectomy.
  
  
  METHODS
  In the 478 consecutive patients who underwent radical cystectomy at our institution from December 2007 to December 2011 we examined the proportion diagnosed with benign ureteroenteric anastomotic stricture. Clinicopathological variables were compared by treatment group. Cox multivariable analysis was performed to determine which patient or disease specific factors were independently associated with stricture diagnosis.
  
  
  RESULTS
  A total of 375 patients (78.5%) underwent open radical cystectomy and 103 (21.5%) underwent robot-assisted laparoscopic radical cystectomy. Of the patients 45 (9.4%) were diagnosed with ureteroenteric anastomotic stricture a median of 5.3 months postoperatively. There was no difference in the stricture rate between the open and robot-assisted groups (8.5% vs 12.6%, p = 0.21). On adjusted Cox proportional hazards analysis no patient variable was independently associated with stricture diagnosis, including operative approach.
  
  
  CONCLUSIONS
  Of the patients 9.4% were diagnosed with benign ureteroenteric anastomotic stricture after radical cystectomy with no significant difference in the risk of diagnosis by surgical approach. No patient or disease specific factor was independently associated with an increased risk of stricture diagnosis. Ureteroenteric anastomotic stricture is likely related to surgical technique. Continued efforts are needed to refine the technique of open and robot-assisted laparoscopic radical cystectomy to minimize the occurrence of this critical complication.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. c.anderson@vanderbilt.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Anderson
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Stephen
authors.initials: S
authors.lastname: Kappa
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*