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KMID : 1001020210190040261
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Journal of Urologic Oncology
2021 Volume.19 No. 4 p.261 ~ p.270
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Perioperative Outcomes of Different Surgical Methods Among Bladder Cancer Patients Undergoing Radical Cystectomy With Neobladder Urinary Diversion
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Kim Hak-Ju
Ye Chang-Hee
Kim Jin-Hyuck
Kim Hwan-Ik
Lee Sang-Chul
Byun Seok-Soo
Oh Jong-Jin
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Abstract
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Purpose: To compare perioperative outcomes according to surgical methods among bladder cancer patients who underwent radical cystectomy (RC) with neobladder urinary diversion.
Materials and Methods: Between June 2007 and January 2020, 89 bladder cancer patients who received RC with neobladder urinary diversion were enrolled in this study. Patients were stratified into surgical methods ? (1) open RC with neobladder (ONB) reconstruction, (2) robot-assisted RC (RARC) with extracorporeal neobladder (ECNB) reconstruction, and (3) RARC with intracorporeal neobladder (ICNB) reconstruction. Perioperative outcomes were compared among the 3 groups, with major complications defined according to Clavien-Dindo grades III? V within 90 days. Logistic regression analysis was performed to identify significant factors for postoperative complications.
Results: Of 89 patients, 28 (31%) had ONB, 31 (35%) had ECNB, and 30 (34%) had ICNB. The median operative time was 471 minutes, and the ICNB group (424.5 minutes) was significantly less than ONB (444.5 minutes) and ECNB groups (542.9 minutes) (p=0.001). Transfusion rate was also significantly less in the ICNB group (13%) (p=0.001). Complications were recorded in 67 patients (75%) and major complications in 22 of all patients (25%). The major complication rate was significantly less in ICNB (13.4%) than in ONB (25%) and ECNB (35%) (p=0.003). Multivariate analysis showed surgical methods (ICNB) (odds ratio [OR], 0.709; p=0.003) and age (OR, 1.150; p=0.001) were significant factors related to occurrence of major postoperative complications.
Conclusions: RARC with ICNB reduces postoperative complications compared to ONB and ECNB.
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KEYWORD
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Urinary bladder neoplasms, Neobladder reconstruction, Postoperative complications
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