Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
Department of Urology, Pontchaillou Hospital, CHU Rennes, Rennes, France.
World J Urol. 2018 Nov;36(11):1711-1718. doi: 10.1007/s00345-018-2313-8. Epub 2018 May 9.
To compare perioperative outcomes and complications of extracorporeal (ECUD) vs intracorporeal urinary diversion (ICUD) in patients after undergoing robot-assisted radical cystectomy (RARC) at five referral centers in France.
We retrospectively reviewed our multi-institutional, prospectively-collected database to select patients undergoing RARC between 2010 and 2016 with at least 3 months of follow-up. At each center, the surgery was performed by one surgeon with extensive experience in robotic surgery and radical cystectomy but no prior experience in RARC.
Overall, 108 patients were included. ECUD and ICUD were performed in 34 (31.5%) and 74 (68.5%) patients, respectively. Patient characteristics were comparable among the two groups, except for a higher proportion of patients with high surgical risk (ASA score ≥ 3) in the ECUD group. Ileal conduit and ileal neobladder were performed in 63/108 (58%) and 45/108 (42%) cases, respectively. Ileal conduit was performed more often with an extracorporeal approach while ileal neobladder with an intracorporeal approach. Overall, operative time, length of hospital stay, positive margin rate, and number of lymph nodes removed did not significantly differ among the two cohorts. Estimated blood loss and transfusion rates were significantly higher in the ECUD group. Rate of early (38.2 vs 47.3%, p = 0.4) and late (29.4 vs 18.9%, p = 0.2) surgical complications did not significantly differ between the ECUD and ICUD groups. Results were comparable in the subgroup analysis in the ileal conduit subpopulation.
In our real-life, multi-institutional study, RARC with ICUD achieved perioperative outcomes and complication rates comparable to those of RARC with ECUD.
比较法国五家转诊中心的机器人辅助根治性膀胱切除术（RARC）后患者的体外（ECUD）与体内（ICUD）尿流改道术的围手术期结果和并发症。
我们回顾性地审查了我们的多机构、前瞻性收集的数据库，以选择 2010 年至 2016 年间接受 RARC 且至少有 3 个月随访的患者。在每个中心，手术均由一位在机器人手术和根治性膀胱切除术方面经验丰富但无 RARC 经验的外科医生进行。
总体而言，纳入了 108 例患者。34 例（31.5%）和 74 例（68.5%）患者分别行 ECUD 和 ICUD。两组患者的特征无差异，除了 ECUD 组中高手术风险（ASA 评分≥3）患者的比例较高。108 例患者中分别有 63 例（58%）和 45 例（42%）患者行回肠导管和回肠新膀胱术。总体而言，ECUD 组中更常使用体外途径进行回肠导管术，而 ICUD 组中更常使用体内途径进行回肠新膀胱术。两组患者的手术时间、住院时间、切缘阳性率和淋巴结清扫数量无显著差异。ECUD 组的估计失血量和输血率显著较高。ECUD 组和 ICUD 组的早期（38.2%比 47.3%，p=0.4）和晚期（29.4%比 18.9%，p=0.2）手术并发症发生率无显著差异。回肠导管亚组分析的结果也相似。
在我们的真实、多机构研究中，ICUD 的 RARC 取得了与 ECUD 的 RARC 相似的围手术期结果和并发症发生率。
