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Minerva Urologica e Nefrologica 2020 October;72(5):519-30

DOI: 10.23736/S0393-2249.20.03829-1


language: English

Intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy: evidence from a systematic review and pooled analysis of observational studies

Dechao FENG, Yin TANG, Yubo YANG, Ping HAN, Wuran WEI

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China

INTRODUCTION: We aimed to compare the perioperative, pathological and oncological outcomes of patients undergoing extracorporeal urinary diversion (EUD) and intracorporeal urinary diversion (IUD) following robot-assisted radical cystectomy (RARC).
EVIDENCE ACQUISITION: Multiple scientific databases were searched up to January 2020 for comparative studies comparing IUD and EUD. The data was analyzed by Review Manager 5.3.
EVIDENCE SYNTHESIS: A total of 9 observational studies comprising 3582 patients were included in the final analysis. We observed that IUD approach were significantly associated with lower estimated blood loss (EBL) (MD: -90.50, 95% CI: -131.26 to -49.74, P<0.0001), fewer gastrointestinal complications (RR: 0.65; 95% CI: 0.45 to 0.93; P=0.02), and lower risk of uretero-ileal anastomotic stricture (RR: 0.36; 95% CI: 0.14 to 0.91; P=0.03). We did not detect significant difference in terms of length of stay (P=0.14), operative time (P=0.55), blood transfusion (P=0.10), 30-day complication (P=0.50), 90-day complication (P=0.40), 30-day readmission (P=0.12), 90-day readmission (P=0.95), positive surgical margins (P=0.42), lymph node yield (P=0.13), 30-day reoperation (P=0.11) and 90-day mortality (0.27) between IUD and EUD.
CONCLUSIONS: The approach of urinary diversion does not have a considerable impact on pathological, perioperative and oncological outcomes in patients undergoing RARC. The benefits conferred by IUD are lower EBL, lower risk of gastrointestinal complications, and uretero-ileal anastomotic stricture. Subgroup analysis of patients with ileal conduit showed similar results on perioperative and complication outcomes. Well-designed trials conducted by large volumes and experienced surgeons, and reporting complications based on standardized methodology are still warranted.

KEY WORDS: Urinary diversion; Robotics; Cystectomy; Meta-analysis

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