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Thomas Flaig, MD


Robotic-Assisted Radical Cystectomy: Comparing Two Urinary Diversion Techniques

By: Julia Fiederlein Cipriano, MS
Posted: Thursday, September 28, 2023

According to Reza Mehrazin, MD, of the Icahn School of Medicine at Mount Sinai, New York, and colleagues, patients with bladder cancer who underwent robotic-assisted radical cystectomy with intracorporeal urinary diversion using the neobladder versus ileal conduit technique experienced similar complications and improved overall survival outcomes. The results of this large, single-institutional comparative analysis were published in the Asian Journal of Urology.

The investigators focused on patients who underwent robotic-assisted radical cystectomy with intracorporeal ileal conduit (n = 190) or neobladder (n = 71) urinary diversion. Those who underwent ileal conduit urinary diversion were found to have a higher postoperative cancer stage (pT2: 17.9% vs. 14.1%; P = .008) and increased nodal involvement (pN2–N3: 14.7% vs. 4.2%; P < .001).

Ileal conduit versus neobladder urinary diversion seemed to result in a shorter median operative time (272 vs. 341 minutes; P < .001) and less estimated blood loss (250 vs. 325 mL; P = .002). Complications were reported in 44.4% of patients at 30 days and 50.2% at 90 days; the rates seemed to be comparable between the groups. A total of 10.3% and 13.0% of patients were found to experience Clavien-Dindo complications of grades 3 to 5 within 30 and 90 days, respectively, also with comparable rates between the groups.

The 24-month Kaplan-Meier estimate for overall survival was 89.0% with ileal conduit urinary diversion and 93.0% with neobladder urinary diversion (hazard ratio [HR] = 1.23; P = .02). In terms of recurrence-free survival, the 24-month Kaplan-Meier estimates were 74.0% and 87.0% with ileal conduit and neobladder urinary diversion, respectively (HR = 1.81; P = .10).

“Our data demonstrate the biggest differences between these two groups were in baseline characteristics and perioperative data,” the investigators concluded. “Further studies, especially prospective ones, are needed to fully characterize the major differences between the two groups.”  

Disclosure: The study authors reported no conflicts of interest.

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