Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

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Abstract

Purpose: This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database. Materials and Methods: We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy. Results: In our cohort 1,094 patients (51%) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4% vs 19%, all p <0.001). They experienced more high grade complications (13% vs 10%, p = 0.02). Intracorporeal urinary diversion use increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95% CI 1.01–1.03, p <0.002), year of robot-assisted radical cystectomy (2013–2016 OR 68, 95% CI 44–105, p <0.001) and American Society of Anesthesiologists® score less than 3 (OR 1.75, 95% CI 1.38–2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001). Conclusions: The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time.

Original languageEnglish
Pages (from-to)1302-1311
Number of pages10
JournalJournal of Urology
Volume199
Issue number5
DOIs
Publication statusPublished - 2018 May

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Urinary Diversion
Cystectomy
Robotics
Operative Time
Logistic Models
Patient Readmission
Blood Transfusion

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

@article{018809e7d9d245c6a2642c599e793591,
title = "Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium",
abstract = "Purpose: This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database. Materials and Methods: We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy. Results: In our cohort 1,094 patients (51{\%}) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4{\%} vs 19{\%}, all p <0.001). They experienced more high grade complications (13{\%} vs 10{\%}, p = 0.02). Intracorporeal urinary diversion use increased from 9{\%} of all urinary diversions in 2005 to 97{\%} in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95{\%} CI 1.01–1.03, p <0.002), year of robot-assisted radical cystectomy (2013–2016 OR 68, 95{\%} CI 44–105, p <0.001) and American Society of Anesthesiologists{\circledR} score less than 3 (OR 1.75, 95{\%} CI 1.38–2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001). Conclusions: The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time.",
author = "Collaborators and Hussein, {Ahmed A.} and May, {Paul R.} and Zhe Jing and Ahmed, {Youssef E.} and Wijburg, {Carl J.} and Canda, {Abdulla Erdem} and Prokar Dasgupta and {Shamim Khan}, Mohammad and Mani Menon and Peabody, {James O.} and Abolfazl Hosseini and John Kelly and Alexandre Mottrie and Jihad Kaouk and Ashok Hemal and Peter Wiklund and Guru, {Khurshid A.} and Andrew Wagner and Matthias Saar and Michael Stockle and Redorta, {Joan Palou} and Lee Richstone and Ketan Badani and Douglas Scherr and Hijab Khan and Franco Gaboardi and Rha, {Koon Ho} and Omar Kawa and Tan, {Wei Shen} and Francis Schanne and Vassilis Polakis and Alon Weizer and Maatman, {Thomas J.} and Giovannalberto Pini and Peak, {Taylor C.} and Adam Kibel and Bertram Yuh",
year = "2018",
month = "5",
doi = "10.1016/j.juro.2017.12.045",
language = "English",
volume = "199",
pages = "1302--1311",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "5",

}

Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy : Results from the International Robotic Cystectomy Consortium. / Collaborators.

In: Journal of Urology, Vol. 199, No. 5, 05.2018, p. 1302-1311.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy

T2 - Results from the International Robotic Cystectomy Consortium

AU - Collaborators

AU - Hussein, Ahmed A.

AU - May, Paul R.

AU - Jing, Zhe

AU - Ahmed, Youssef E.

AU - Wijburg, Carl J.

AU - Canda, Abdulla Erdem

AU - Dasgupta, Prokar

AU - Shamim Khan, Mohammad

AU - Menon, Mani

AU - Peabody, James O.

AU - Hosseini, Abolfazl

AU - Kelly, John

AU - Mottrie, Alexandre

AU - Kaouk, Jihad

AU - Hemal, Ashok

AU - Wiklund, Peter

AU - Guru, Khurshid A.

AU - Wagner, Andrew

AU - Saar, Matthias

AU - Stockle, Michael

AU - Redorta, Joan Palou

AU - Richstone, Lee

AU - Badani, Ketan

AU - Scherr, Douglas

AU - Khan, Hijab

AU - Gaboardi, Franco

AU - Rha, Koon Ho

AU - Kawa, Omar

AU - Tan, Wei Shen

AU - Schanne, Francis

AU - Polakis, Vassilis

AU - Weizer, Alon

AU - Maatman, Thomas J.

AU - Pini, Giovannalberto

AU - Peak, Taylor C.

AU - Kibel, Adam

AU - Yuh, Bertram

PY - 2018/5

Y1 - 2018/5

N2 - Purpose: This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database. Materials and Methods: We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy. Results: In our cohort 1,094 patients (51%) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4% vs 19%, all p <0.001). They experienced more high grade complications (13% vs 10%, p = 0.02). Intracorporeal urinary diversion use increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95% CI 1.01–1.03, p <0.002), year of robot-assisted radical cystectomy (2013–2016 OR 68, 95% CI 44–105, p <0.001) and American Society of Anesthesiologists® score less than 3 (OR 1.75, 95% CI 1.38–2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001). Conclusions: The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time.

AB - Purpose: This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database. Materials and Methods: We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy. Results: In our cohort 1,094 patients (51%) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4% vs 19%, all p <0.001). They experienced more high grade complications (13% vs 10%, p = 0.02). Intracorporeal urinary diversion use increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95% CI 1.01–1.03, p <0.002), year of robot-assisted radical cystectomy (2013–2016 OR 68, 95% CI 44–105, p <0.001) and American Society of Anesthesiologists® score less than 3 (OR 1.75, 95% CI 1.38–2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001). Conclusions: The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time.

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DO - 10.1016/j.juro.2017.12.045

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