Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol
Urology Journal,
Vol. 21 No. 01 (2024),
28 Esfand 2024
,
Page 40-46
https://doi.org/10.22037/uj.v20i.7752
Abstract
Purpose: It is unclear if robotic radical cystectomy with extracorporeal urinary diversion (eRARC) provides additional
benefit when performed along with enhanced recovery after surgery (ERAS). We assessed the additional
efficacy of eRARC in terms of perioperative outcomes.
Materials and Methods: We retrospectively assessed 143 patients undergoing radical cystectomy with urinary
diversion between June 2010 and December 2021 at a single center. The patients were assigned to three groups:
open radical cystectomy (ORC) with conventional recovery after surgery (CRAS) [Group A], ORC with ERAS
[Group B], and eRARC with ERAS [Group C]. A propensity score-matched analysis was performed to evaluate
how ERAS and eRARC affected outcomes respectively. Meanwhile, multivariable analysis was used to detect the
predictors of prolonged length of hospital stay (LOS).
Results: The median LOS was shorter after ERAS and eRARC. In the propensity score-matched analysis, ERAS
was linked to a significantly shorter median LOS (28.0 vs. 20.0 days, P < .001), but eRARC was not associated
with a shorter LOS (19.0 vs. 17.5 days, P = .21). Neither ERAS nor eRARC were connected with a reduce in complication rate. Following multivariable analysis, ERAS was found to be independently associated with shorter LOS (OR=0.23, P < .001), but eRARC demonstrated no such correlation (OR=0.29, P = .096).
Conclusion: ERAS had strong association with shorter LOS, although eRARC did not contribute to additional
efficacy. Neither ERAS nor eRARC decreased the complication rate.
- robot-assisted radical cystectomy, enhanced recovery after surgery, extracorporeal urinary diversion, length of hospital stay, complication rate, postoperative outcomes
How to Cite
References
Witjes JA, Bruins HM, Cathomas R et al. European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur Urol. 2021;79:82-104.
Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Roder MA. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open 2021;4:e043266.
Cerantola Y, Valerio M, Persson B et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced recovery after surgery (ERAS((R)) society recommendations. Clin Nutr. 2013;32:879-87.
Zhang D, Sun K, Wang T et al. Systematic review and meta-analysis of the efficacy and safety of enhanced recovery after surgery vs. conventional recovery after surgery on perioperative outcomes of radical cystectomy. Front Oncol. 2020;10:541390.
Wessels F, Lenhart M, Kowalewski KF et al. Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World J Urol. 2020;38:3139-53.
Zamboni S, Soria F, Mathieu R et al. Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in perioperative outcomes among selected centers in North America and Europe: an international multicenter collaboration. BJU Int. 2019;124:656-64.
Hu X, Xiong SC, Dou WC et al. Minimally invasive vs open radical cystectomy in patients with bladder cancer: a systematic review and meta-analysis of randomized controlled trials. Eur J Surg Oncol. 2020;46:44-52.
Parekh DJ, Reis IM, Castle EP et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomized, phase 3, non-inferiority trial. Lancet. 2018; 391:2525-36.
Zhou N, Tian F, Feng Y et al. Perioperative outcomes of intracorporeal robot-assisted radical cystectomy versus open radical cystectomy: a systematic review and meta-analysis of comparative studies. Int J Surg. 2021;94:106137.
Tan WS, Tan MY, Lamb BW et al. Intracorporeal robot-assisted radical cystectomy, together with an enhanced recovery program, improves postoperative outcomes by aggregating marginal gains. BJU Int. 2018;121:632-9.
Tan YG, Allen JC, Tay KJ, Huang HH, Lee LS. Benefits of robotic cystectomy compared with open cystectomy in an enhanced recovery after surgery program: a propensity-matched analysis. Int J Urol. 2020;27:783-8.
Chen J, Djaladat H, Schuckman AK et al. Surgical approach as a determinant factor of clinical outcome following radical cystectomy: does enhanced recovery after surgery (ERAS) level the playing field? Urol Oncol. 2019;37:765-73.
Schiavina R, Droghetti M, Bianchi L et al. The robotic approach improves the outcomes of ERAS protocol after radical cystectomy: a prospective case-control analysis. Urol Oncol. 2021;39:833.e1-.e8.
Katayama S, Mori K, Pradere B et al. Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis. Int J Clin Oncol. 2021;26:1587-99.
Naito Y, Kanazawa H, Okada Y et al. Adoption of enhanced recovery after surgery (eras) protocol for the management of patients undergoing radical cystectomy in Japan. Nihon Hinyokika Gakkai Zasshi. 2020;111:9-15 (in Japanese).
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452-8.
Williams SB, Cumberbatch MGK, Kamat AM et al. Reporting radical cystectomy outcomes following implementation of enhanced recovery after surgery protocols: a systematic review and individual patient data meta-analysis. Eur Urol. 2020;78:719-30.
Ahmed K, Khan SA, Hayn MH et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65:340-7.
Hussein AA, May PR, Jing Z et al. Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy: results from the international robotic cystectomy consortium. J Urol 2018;199:1302-11.
Kimura S, Iwata T, Shariat SF et al. Comparison of perioperative complications and health-related quality of life between robot-assisted and open radical cystectomy: a systematic review and meta-analysis. Int J Urol. 2019;26:760-74.
Feng D, Liu S, Lu Y, Wei W, Han P. Clinical efficacy and safety of enhanced recovery after surgery for patients treated with radical cystectomy and ileal urinary diversion: a systematic review and meta-analysis of randomized controlled trials. Transl Androl Urol. 2020;9:1743-53.
Tan WS, Lamb BW, Kelly DJ et al. In-depth critical analysis of complication following robot-assisted radical cystectomy with intracorporeal urinary diversion. Eur Urol Focus. 2017;3:273-9.
Yu A, Wang Y, Mossanen M et al. Robotic-assisted radical cystectomy is associated with lower perioperative mortality in octogenarians. Urol Oncol.2022;40:163.e19-e23.
Yamada S, Abe T, Sazawa A et al. Comparative study of postoperative complications
after radical cystectomy during the past two decades in Japan: radical cystectomy remains associated with significant postoperative morbidities. Urol Oncol 2022;40:11.e17-e25.
Muto S, Kitamura K, Ieda T et al. A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: initial experience. Investig Clin Urol. 2017;58:171-8.
Gondo T, Yoshioka K, Nakagami Y et al. Robotic versus open radical cystectomy: prospective comparison of perioperative and pathologic outcomes in Japan. Jpn J Clin Oncol. 2012;42:625-31.
Llorente C, Guijarro A, Hernandez V et al. Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success. World J Urol. 2020;38:3121-9.
Mastoriannni R, Ochoa Arvizo MA, Torregiani G, Simone G. Robot-assisted vs open radical cystectomy: randomized controlled trials lights and shadows. J Urol. 2023;209:460-1.
Zhang JH, Ericson KJ, Thomas LJ, et al. Large single institution comparison of perioperative outcomes and complications of open radical cystectomy, intracorporeal robot-assisted radical cystectomy and robotic extracorporeal approach. J Urol. 2020;203:512-21.
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