title: Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
abstract: BACKGROUND
  Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance.
  
  
  OBJECTIVE
  To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC).
  
  
  METHODS
  We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011.
  
  
  METHODS
  All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally.
  
  
  METHODS
  Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables.
  
  
  CONCLUSIONS
  Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p=0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p=0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p=0.02). Being a retrospective study was the main limitation.
  
  
  CONCLUSIONS
  Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.
authors.forename: Shahid A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Maine Medical Center, Division of Urology, Portland, ME, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Hayn
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: Piyush K
authors.initials: PK
authors.lastname: Agarwal
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.affiliation: Memorial Şişli Hospital, Istanbul, Turkey.
authors.forename: M Derya
authors.initials: MD
authors.lastname: Balbay
authors.affiliation: Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.
authors.forename: Prokar
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authors.lastname: Dasgupta
authors.affiliation: Montefiore Medical Center, UN Hospital Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Reza
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authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address: khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
authors.affiliation: Wake Forest University Baptist Medical Center, Salem, NC, USA.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mani
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authors.lastname: Menon
authors.affiliation: Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: Alex
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authors.lastname: Mottrie
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Kenneth
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authors.lastname: Nepple
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Pattaras
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Doctor's Hospital of Athens, Athens, Greece.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Poulakis
authors.affiliation: University of North Carolina, NC, USA.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.affiliation: Fundacio Puigvert, Barcelona, Spain.
authors.forename: Joan Palou
authors.initials: JP
authors.lastname: Redorta
authors.affiliation: Yonsei University Health Systems Severance Hospital, Seoul, Korea.
authors.forename: Koon-Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Arthur Smith Institute for Urology, New Hyde Park, NY, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.affiliation: University Clinics of Saarland, Homburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Saar
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.affiliation: University Clinics of Saarland, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.affiliation: University Clinics of Saarland, Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stoeckle
authors.affiliation: University of North Carolina, NC, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
authors.affiliation: City of Hope and Beckman Research Institute, Duarte, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.affiliation: Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Woods
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.
authors.forename: Muhammad Shamim
authors.initials: MS
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*
keywords: Complications; Extracorporeal urinary diversion; Intracorporeal urinary diversion; Outcomes; Robot-assisted; Robotic radical cystectomy; Urinary diversion