Analysis of Intracorporeal Compared with Extracorporeal Urinary Diversion After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
Analysis of Intracorporeal Compared with Extracorporeal Urinary Diversion After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium
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DOI：
10.1016/j.eururo.2013.09.042
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发表时间：
2014-02-01
期刊：
影响因子：
23.4
通讯作者：
Khan, Muhammad Shamim
中科院分区：
文献类型：
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作者：
Ahmed, Kamran;Khan, Shahid A.;Khan, Muhammad Shamim
背景资料：颅内尿流改道术（ICUD）的潜在益处是切口更小、疼痛减轻、肠道暴露减少、体液失衡风险降低。目的：比较接受体外尿流改道术（ECUD）和机器人辅助根治性膀胱切除术（RARC）后ICUD患者的围手术期结局。设计、设置和参与者：我们回顾了国际机器人机器人联盟（IRCC）的数据库，（18个国际中心），2003年至2011年期间接受RARC和盆腔淋巴结清扫术（PLND）的935例患者。IRCC内的所有患者均按指示接受了RARC和PLND。结果测量和统计分析：人口学资料，围手术期的结果，并进行ICUD或ECUD患者的并发症进行了比较。所有患者至少随访90天。Fisher精确检验用于总结分类变量，Wilcoxon秩和检验或Kruskal-Wallis检验用于连续变量。结果和局限性：在935例患有RARC和PLND的患者中，167例患者接受了ICUD（回肠导管：106;新膀胱：61），768例患者接受了ECUD（回肠导管：570;新膀胱：198）。817例患者的术后并发症数据可用，至少随访90 d。两组之间在年龄、性别、体重指数、美国麻醉医师协会分级或既往腹部手术率方面没有差异。手术时间相当（414分钟），ICUD组的中位住院时间略长（9天vs 8天，p = 0.086）。两组在30天时的再手术率无差异。两组之间的90天并发症发生率不显著，但观察到ICUD优于ECUD的趋势（41% vs 49%，p = 0.05）。ICUD组的胃肠道并发症明显较低（p
Background: Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance.Objective: To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC).Design, setting, and participants: We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011.Intervention: All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally.Outcome measurements and statistical analysis: Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables.Results and limitations: Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p = 0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p = 0.05). Gastrointestinal complications were significantly lower in the ICUD group (p