Robot-assisted radical cystectomy with intracorporeal urinary diversion decreases postoperative complications only in highly comorbid patients: findings that rely on a standardized methodology recommended by the European Association of Urology Guidelines

• Published in: World journal of urology 2021-03, Vol.39 (3), p.803-812
• Main Authors: Mazzone, Elio, D’Hondt, Frederiek, Beato, Sergi, Andras, Iulia, Lambert, Edward, Vollemaere, Jonathan, Covas Moschovas, Marcio, De Groote, Ruben, De Naeyer, Geert, Schatteman, Peter, Mottrie, Alexandre, Dell’Oglio, Paolo
• Format: Article
• Language: English
• Subjects: Bladder cancer; Comorbidity; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Patients; Postoperative period; Regression analysis; Robots; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-020-03237-5

Introduction The available studies comparing robot-assisted radical cystectomy (RARC) with intracorporeal (ICUD) vs. extracorporeal (ECUD) urinary diversion have not relied on a standardized methodology to report complications and did not assess the effect of different approaches on postoperative outcomes. Materials Two hundred and sixty seven patients treated with RARC at a single center were assessed. A retrospective analysis of data prospectively collected according to a standardized methodology was performed. Multivariable logistic regression models (MVA) assessed the impact of ICUD vs. ECUD on intraoperative complications, prolonged length of stay (LOS), 30-day Clavien Dindo (CD) ≥ 2 complications and readmission rate. Interaction terms tested the impact of the approach on different patient subgroups. Lowess graphically depicted the probability of CD ≥ 2 after ICUD or ECUD according to patient baseline characteristics. Results Overall, 162 ICUD vs 105 ECUD (61 vs. 39%) were performed. Intraoperative complications were recorded in 24 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 were recorded. The overall rate of CD ≥ 2 was 35 and 43% in patients with ICUD vs. ECUD, respectively ( p  = 0.2). At MVA, the approach type was not an independent predictor of any postoperative outcomes (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 significant interaction term between ACCI and approach type ( p  = 0.04), where patients with ICUD had lower risk of CD ≥ 2 relative to those with ECUD with increasing ACCI. 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.