| Objective: To compare the perioperative indexes and postoperative complications of extracorporeal urinary diversion(ECUD)and intracorporeal urinary diversion(ICUD)after robot-assisted radical cystectomy(RARC).Methods: 125 consecutive patients who underwent robot-assisted radical cystectomy in our center from March 2016 to January 2019 were studied.Among which,37 patients met the inclusion criteria,16 patients underwent extracorporeal urinary diversion,and 15 were male,1 female.21 patients underwent urinary diversion in vivo,18 males and 3 females.The case report form has been established to obtain and collect data for statistical analysis by consulting medical records,outpatient,emergency data and telephone follow-up.Results: The baseline data of patients in ECUD group and ICUD group were comparable,and there was no significant difference in gender,age,BMI and tumor stage between the two groups.The intraoperative blood loss was(322 ± 127)ml and(490 ± 239)ml,the intraoperative blood transfusion rate was 19% and 33%,and the operation time was(417 ± 61)min and(502 ± 98)min,respectively.The total number of lymph node dissection was(16 ± 6)and(17 ± 5),respectively.The median time to oral solids was 4 and 3 days,respectively.IQR was(3-5.75)and(2-3.5)days, respectively.The median postoperative hospital stay was 14 and 18 days,IQR was(12-17)and(12.5-22.5)days,respectively.The differences in intraoperative blood loss,operation time and postoperative return to food intake between the two groups had statistical significance.The changes of albumin before and after operation were(7 ± 4)and(7 ± 3)g/ L,respectively.The changes of C-reactive protein before and after operation were(33 ± 26)and(46 ± 38)mg/ L,respectively.The changes of hemoglobin before and after operation were(15 ± 12)and(16 ± 16)g/ L,respectively.The complication rate within 30 days after operation was 44% and 33%,the complication rate within 90 days after operation was 50% and 43%,and the readmission rate within 90 days was 31% and 19%,respectively.There were no statistically significant differences in changes in intraoperative blood transfusion rate,total number of lymph node dissection,postoperative hospital stay,C-reactive protein,hemoglobin,albumin before and after operation,complication rate within 30 days,complication rate within 90 days,and readmission rate within 90 days.Subgroup analysis showed that the median time to oral solids was 4 days in the extracorporeal ileal bladder group and 3 days in the intracorporeal ileal bladder group,respectively,with statistically significant difference(p = 0.009).There was no significant difference in the blood loss and operation time between the two groups.During the follow-up period of 3-22 months,there was 1 case of pelvic recurrence progression and 2 cases of distant metastasis in ECUD group;In ICUD group,1 case had lung metastasis and 1 case had abdominal wall and abdominal cavity metastasis.There was one death due to bladder cancer in the ECUD group and one death in the ICDU group,and there was no significant difference in survival curves between the two groups.Ureteral stricture rates were 8% in the ECUD group and 7% in the ICUD group.In 7 patients with neobladder,the total urinary continence rate was 86% during the day and 57% during the night.Urodynamic examination in the orthotopic neobladder showed that the average volume of neobladder was 442 ml,and the average maximum urine flow rate was 6.5 ml/ s.Conclusion: The safety of intracorporeal ileal bladder was similar to that of in extracorporeal ileal bladder,which could reduce the time to oral solids after operation.Robotic-assisted intracorporeal urinary diversion takes longer. |
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