Intracorporeal versus extracorporeal urinary diversion following robot-assisted radical cystectomy: a meta-analysis, cum
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REVIEW ARTICLE
Intracorporeal versus extracorporeal urinary diversion following robot‑assisted radical cystectomy: a meta‑analysis, cumulative analysis, and systematic review Karthik Tanneru1 · Seyed Behzad Jazayeri1 · Jatinder Kumar1 · Muhammad Umar Alam1 · Daniel Norez2 · Sabine Nguyen1 · Soroush Bazargani1 · Hariharan Palayapalayam Ganapathi1 · Mark Bandyk1 · Robert Marino1 · Shahriar Koochekpour1 · Shiva Gautam1 · K. C. Balaji1 · Joseph Costa1 Received: 9 September 2020 / Accepted: 11 November 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Over the last decade, the increased utilization of robot-assisted radical cystectomy (RARC) in the surgical treatment of muscle-invasive bladder cancer has led to an uptrend in intracorporeal urinary diversions (ICUD). However, the operative results comparing ICUD to extracorporeal urinary diversion (ECUD) have varied widely. We performed a meta-analysis to analyze perioperative outcomes and complications of ICUD compared to ECUD following RARC. This study is registered at International Prospective Register of Systematic Reviews (PROSPERO) CRD42020164074. A systematic literature review was conducted using PubMed, EMBASE, and Cochrane databases in August 2019. A total of six studies comparing ICUD vs ECUD were identified and meta-analysis was conducted on these studies. In addition, a cumulative analysis was also performed on 83 studies that reported perioperative outcomes after RARC and ICUD or ECUD. The Weighed Mean Difference of operative time and blood loss between ICUD and ECUD group was (16; 95% confidence interval − 34 to 66) and (− 86; 95% confidence interval − 124 to − 48), respectively. ICUD and ECUD had comparable early (30-day) and midterm (30–90-day) complication rate (RR 1.19; 95% confidence interval 0.71–2.0; p = 0.5) and (RR 0.91; 95% confidence interval 0.71–1.15 p = 0.4) respectively. In the 83 studies that were included in the cumulative analysis, the mean operative time for ileal conduit and neobladders by ICUD were 307 and 428 min, respectively, compared to ECUD 428 and 426 min, respectively. ICUD and ECUD have comparable short- and mid-term complication rate. The ICUD group has lower blood loss and lower rate of blood transfusion compared to ECUD. Keywords ICUD · ECUD · Intracorporeal urinary diversion · Extracorporeal urinary diversion · RARC
Introduction Radical cystectomy with bilateral pelvic lymph-node dissection (PLND) has been the gold standard treatment for patients with non-metastatic muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer [1–3]. Over the last decade, robot-assisted radical cystectomy (RARC) has been increasingly utilized and shown to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11701-020-01174-4) contains supplementary material, which is available to authorized users. * Joseph Costa [email protected] Extended author information available on the last page of the article
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