Perioperative Outcomes and Complications after Robotic Radical Cystectomy with Intra-Corporeal or Extra-Corporeal Ileal Conduit Urinary Diversion: Head-to-head Comparison from a Single-Institutional Prospective Study.

OBJECTIVE: to compare perioperative and oncological outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion ECUD after robot-assisted radical cystectomy (RARC).

METHODS: From January 2014 to December 2017, data of consecutive patients who underwent RARC performed by 2 institutional surgeons were prospectively collected in a dedicated database (IRB: 251647). Patients were divided in 2 groups according to the operating surgeon, one performing ECUD, the other ICUD. Groups were compared in perioperative outcomes and Clavien complications (during admission, within 30- and 90-days postoperatively). Univariable and multivariable analyses tested the impact of variables of interest on the occurrence of complications at the different time points. Kaplan-Meier method was used to estimate recurrence and metastasis-free survivals.

RESULTS: 60 and 66 patients underwent RARC with ileal conduit ICUD and ECUD, respectively. ICUD patients were younger (69 vs 73 years-old, p=0.009). No differences were found in other baseline characteristics and final pathology. Regarding perioperative outcomes, shorter operative time favored ECUD (7 vs 6 hours, p=0.0004). Specifically, no differences were found in postoperative complications while admitted, either overall (ICUD: 16 (26.7%) vs ECUD: 23 (34.8%) patients, p=0.3) or major (ICUD: 10 (16.7%) vs ECUD: 14 (21.2%), p=0.6); same was for reassessment within 30- and 90-days postoperatively. At multivariable analysis, CCI ≥3 and blood losses >600 ml predicted complications during the admission (p=0.02). Male gender, higher BMI and ureteral involvement predicted 30-days complications (p=0.04). No differences in oncological outcomes.

CONCLUSIONS: At head-to-head comparison of two expert surgeons, ICUD and ECUD for ileal conduit had comparable perioperative outcomes.