Comparative outcomes of intracorporeal and extracorporeal urinary diversion in robotic cystectomy: a systematic review and meta-analysis.

This study aimed to elucidate the most recent evidence regarding complications, perioperative outcomes, and pathological results associated with extracorporeal urinary diversion (ECUD) in comparison to intracorporeal urinary diversion (ICUD) during robotic-assisted radical cystectomy (RARC). A systematic review and meta-analysis were conducted to facilitate this comparison. We conducted a thorough systematic review of relevant studies by systematically searching several databases, including PubMed, Embase, Cochrane Library, and Web of Science, to assess the implications of ICUD versus ECUD in the context of RARC. The examination of binary variables employed relative risk (RR) measurements, whereas weighted mean differences (WMD) served as the primary metric for evaluating continuous variable outcomes. Twenty-two studies involving 8030 patients were included, of which 3755 received ICUD and 4278 received ECUD. Baseline characteristics were similar in the two cohorts. The study showed that the ICUD cohort had a notably lower rate of severe complications in the late phase (30-90 day) [RR = 0.71, 95% CI = 0.54, 0.94, p = 0.016] than the ECUD group. Furthermore, the rate of intraoperative transfusions was notably less in ICUD, with a RR of 0.63 (95% CI 0.47, 0.84, p = 0.002). Likewise, the estimated blood loss (EBL) in the ICUD cohort was decreased, reflected by a WMD of - 131.4 (95% CI - 153.24 to - 111.03, p < 0.001). Additionally, length of stay for patients in the ICUD cohort showed a notably decrease, indicated by a WMD of - 1.87 (95% CI - 3.34, - 0.41, p = 0.004). Nonetheless, there was still no notable variation between the two cohorts regarding early (30 days) complications, mid-term (30-90 days) mild complications, rehospitalization rates, operative time (OT), postoperative venting time, tumor recurrence rates, ureteroenteric stricture (UES), and oncologic outcomes. Overall, RARC with ICUD demonstrated a greater safety profile than ECUD in terms of reduced late serious complication rates, transfusion rates, EBL, and length of hospitalization, along with similar efficacy. Although ICUD has good potential for clinical dissemination, further substantial follow-up data are required to substantiate its effectiveness.