A Meta-analysis Comparing The Efficacy Between Intracorporeal And Extracorporeal Urinary Diversion After Robotic-assisted Laparoscopic Radical Cystectomy

Objective:Robotic-assisted in intracorporeal urinary diversion after radical laparoscopic bladder cancer surgery is increasingly used worldwide,and the clinical efficacy of intracorporeal and extracorporeal urinary diversion after radical laparoscopic bladder cancer surgery was evaluated by means of Meta-analysis to provide more evidence-based medical evidence for clinical practice.Methods:The system retrieved literature on comparing perioperative indicators of RARC-ICUD and RARC-ECUD published in PubMed database,Cochrane Library,Web of Science database,China Knowledge Base,and Wanfang database from January 2023,and the literature was screened according to inclusion and exclusion criteria,and literature information was extracted as required.The study indicators included: operative time,surgical bleeding volume,blood transfusion rate,length of stay,overall complication rate within 30 days postoperatively,complication rate within 90 days postoperatively,readmission rate within 30 days postoperatively,readmission rate within 90 days postoperatively,intestinal complication rate,and uretero-ileal anastomosis stricture rate.The results of the included literature were meta-analyzed by Review Manager 5.3 software.Results:The meta-analysis included 17 papers with a total of 5479 patients,and the results of the Meta-analysis showed that ICUD and ECUD were associated with a higher rate of complications in terms of operative time(WMD: 11.69,95% CI:-15.01～ 38.38,P = 0.39 > 0.05),length of stay(WMD:-0.55,95% CI:-1.60 ～ 0.50,P =0.3 > 0.05),overall complication rate within 30 days postoperatively(OR: 0.98,95%CI :0.70 ～ 1.38,P = 0.90 > 0.05),complication rate within 90 days postoperatively(OR: 0.88,95% CI: 0.59 ～ 1.31,P = 0.52 > 0.05),readmission rate within 30 days postoperatively(OR: 0.90,95% CI :0.71 ～ 1.14,P = 0.40 > 0.05),and readmission rate within 90 days postoperatively(OR: 1.01,95% CI: 0.73 ～ 1.39,P= 0.95 > 0.05)were not significantly different among the 6 outcomes;in the surgical bleeding volume(WMD:-74.88,95% CI:-90.44 ～-59.32,P=0.02 < 0.05),blood transfusion rate(OR: 0.5,95% CI: 0.31～0.81,P=0.005 < 0.05),intestinal complication incidence(OR: 0.64,95% CI: 0.51 ～ 0.81,P=0.0002 < 0.05),and uretero-ileal anastomosis stricture rate(OR: 0.45,95% CI: 0.22 ～ 0.89,P=0.02 < 0.05)were the four indicators in which RARC-ICUD was superior to RARC-ECUD.Conclusion:RARC-ICUD is superior to RARC-ECUD in reducing surgical bleeding,reducing blood transfusion rate,reducing intestinal complication rate,and reducing uretero-ileal anastomosis stenosis rate.For patients with MIBC and high-risk NMIBC,the RARC-ICUD procedure is safe and feasible when the indications for the procedure are met,and can be promoted in clinical practice.