Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Ahmed A. Hussein; Paul R. May; Zhe Jing; Youssef E. Ahmed; Carl J. Wijburg; Abdulla Erdem Canda; Prokar Dasgupta; Mohammad Shamim Khan; Mani Menon; James O. Peabody; Abolfazl Hosseini; John Kelly; Alexandre Mottrie; Jihad Kaouk; Ashok Hemal; Peter Wiklund; Khurshid A. Guru; Andrew Wagner; Matthias Saar; Joan Palou Redorta; Michael Stockle; Lee Richstone; Franco Gaboardi; Ketan Badani; Koon-Ho Rha; Hijab Khan; Omar Kawa; Francis Schanne; Vassilis Polakis; Alon Weizer; Douglas Scherr; Giovannalberto Pini; Wei Shen Tan; Thomas J. Maatman; Adam Kibel; Bertram Yuh; Taylor C. Peak

doi:10.1016/j.juro.2017.12.045

Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Ahmed A. Hussein, Paul R. May, Zhe Jing, Youssef E. Ahmed, Carl J. Wijburg, Abdulla Erdem Canda, Prokar Dasgupta, Mohammad Shamim Khan, Mani Menon, James O. Peabody, Abolfazl Hosseini, John Kelly, Alexandre Mottrie, Jihad Kaouk, Ashok Hemal, Peter Wiklund, Khurshid A. Guru, Andrew Wagner, Matthias Saar, Joan Palou RedortaMichael Stockle, Lee Richstone, Franco Gaboardi, Ketan Badani, Koon-Ho Rha, Hijab Khan, Omar Kawa, Francis Schanne, Vassilis Polakis, Alon Weizer, Douglas Scherr, Giovannalberto Pini, Wei Shen Tan, Thomas J. Maatman, Adam Kibel, Bertram Yuh, Taylor C. Peak

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Abstract

Introduction and Objective This study aims to provide an update and compare perioperative outcomes and complications of Intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following RARC from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC). Methods A retrospective review of 2125 patients from 26 institutions was performed. ICUD was compared with ECUD Multivariate (stepwise variable selection) logistic regression models were fit to evaluate preoperative, operative, and postoperative predictors of receiving ICUD, operative time, high grade complications and 90-days readmissions after RARC. Results 51% (n=1094) patients underwent ICUD in our cohort. ICUD patients demonstrated shorter operative times (357 vs 400 minutes, p<0.001), less blood loss (300 vs 350 ml, p<0.001), and fewer blood transfusions (4% vs 19%, p<0.001). ICUD patients experienced more high grade complications (13 vs 10%, p=0.02). Utilization of ICUD increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after ICUD decreased significantly over time (p<0.001). On multivariable analysis, higher annual cystectomy volume (OR 1.02, 95% CI (1.01-1.03), p<0.002) and year of RARC 2013-2016 (OR 68, 95% CI 44-105, p<0.001) and ASA score <3 (OR 1.75, 95% CI 1.38-2.22, p<0.001) were associated with receiving ICUD. ICUD was associated with shorter operative time (27 minutes, p=0.001). Conclusion Utilization of ICUD has increased over the past decade. Higher annual institutional volume of RARCs was associated with performing ICUD. ICUD was associated with shorter operative times. Although ICUD was associated with higher grade complications compared to ECUD, they decreased over time.

Original language	English
Journal	Journal of Urology
Early online date	21 Dec 2017
DOIs	https://doi.org/10.1016/j.juro.2017.12.045
Publication status	Published - 5 May 2018

Keywords

Robot-assisted
cystectomy
outcomes
intracorporeal
diversion

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Outcomes of Intracorporeal Urinary_HUSSEIN_Publishedonline21December2017_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 525 KBLicence: CC BY-NC-ND

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Hussein, A. A., May, P. R., Jing, Z., Ahmed, Y. E., Wijburg, C. J., Canda, A. E., Dasgupta, P., Shamim Khan, M., Menon, M., Peabody, J. O., Hosseini, A., Kelly, J., Mottrie, A., Kaouk, J., Hemal, A., Wiklund, P., Guru, K. A., Wagner, A., Saar, M., ... Peak, T. C. (2018). Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. Journal of Urology. https://doi.org/10.1016/j.juro.2017.12.045

@article{0460029f0d0341b78e042da90e72d91c,

title = "Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium",

abstract = "Introduction and Objective This study aims to provide an update and compare perioperative outcomes and complications of Intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following RARC from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC). Methods A retrospective review of 2125 patients from 26 institutions was performed. ICUD was compared with ECUD Multivariate (stepwise variable selection) logistic regression models were fit to evaluate preoperative, operative, and postoperative predictors of receiving ICUD, operative time, high grade complications and 90-days readmissions after RARC. Results 51% (n=1094) patients underwent ICUD in our cohort. ICUD patients demonstrated shorter operative times (357 vs 400 minutes, p<0.001), less blood loss (300 vs 350 ml, p<0.001), and fewer blood transfusions (4% vs 19%, p<0.001). ICUD patients experienced more high grade complications (13 vs 10%, p=0.02). Utilization of ICUD increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after ICUD decreased significantly over time (p<0.001). On multivariable analysis, higher annual cystectomy volume (OR 1.02, 95% CI (1.01-1.03), p<0.002) and year of RARC 2013-2016 (OR 68, 95% CI 44-105, p<0.001) and ASA score <3 (OR 1.75, 95% CI 1.38-2.22, p<0.001) were associated with receiving ICUD. ICUD was associated with shorter operative time (27 minutes, p=0.001). Conclusion Utilization of ICUD has increased over the past decade. Higher annual institutional volume of RARCs was associated with performing ICUD. ICUD was associated with shorter operative times. Although ICUD was associated with higher grade complications compared to ECUD, they decreased over time.",

keywords = "Robot-assisted, cystectomy, outcomes, intracorporeal, diversion",

author = "Hussein, {Ahmed A.} and May, {Paul R.} and Zhe Jing and Ahmed, {Youssef E.} and Wijburg, {Carl J.} and Canda, {Abdulla Erdem} and Prokar Dasgupta and {Shamim Khan}, Mohammad and Mani Menon and Peabody, {James O.} and Abolfazl Hosseini and John Kelly and Alexandre Mottrie and Jihad Kaouk and Ashok Hemal and Peter Wiklund and Guru, {Khurshid A.} and Andrew Wagner and Matthias Saar and Redorta, {Joan Palou} and Michael Stockle and Lee Richstone and Franco Gaboardi and Ketan Badani and Koon-Ho Rha and Hijab Khan and Omar Kawa and Francis Schanne and Vassilis Polakis and Alon Weizer and Douglas Scherr and Giovannalberto Pini and Tan, {Wei Shen} and Maatman, {Thomas J.} and Adam Kibel and Bertram Yuh and Peak, {Taylor C.}",

year = "2018",

month = may,

day = "5",

doi = "10.1016/j.juro.2017.12.045",

language = "English",

journal = "Journal of Urology",

issn = "0022-5347",

publisher = "Elsevier Inc.",

}

Hussein, AA, May, PR, Jing, Z, Ahmed, YE, Wijburg, CJ, Canda, AE, Dasgupta, P , Shamim Khan, M, Menon, M, Peabody, JO, Hosseini, A, Kelly, J, Mottrie, A, Kaouk, J, Hemal, A, Wiklund, P, Guru, KA, Wagner, A, Saar, M, Redorta, JP, Stockle, M, Richstone, L, Gaboardi, F, Badani, K, Rha, K-H, Khan, H, Kawa, O, Schanne, F, Polakis, V, Weizer, A, Scherr, D, Pini, G, Tan, WS, Maatman, TJ, Kibel, A, Yuh, B & Peak, TC 2018, 'Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium', Journal of Urology. https://doi.org/10.1016/j.juro.2017.12.045

TY - JOUR

T1 - Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy

T2 - Results from the International Robotic Cystectomy Consortium

AU - Hussein, Ahmed A.

AU - May, Paul R.

AU - Jing, Zhe

AU - Ahmed, Youssef E.

AU - Wijburg, Carl J.

AU - Canda, Abdulla Erdem

AU - Dasgupta, Prokar

AU - Shamim Khan, Mohammad

AU - Menon, Mani

AU - Peabody, James O.

AU - Hosseini, Abolfazl

AU - Kelly, John

AU - Mottrie, Alexandre

AU - Kaouk, Jihad

AU - Hemal, Ashok

AU - Wiklund, Peter

AU - Guru, Khurshid A.

AU - Wagner, Andrew

AU - Saar, Matthias

AU - Redorta, Joan Palou

AU - Stockle, Michael

AU - Richstone, Lee

AU - Gaboardi, Franco

AU - Badani, Ketan

AU - Rha, Koon-Ho

AU - Khan, Hijab

AU - Kawa, Omar

AU - Schanne, Francis

AU - Polakis, Vassilis

AU - Weizer, Alon

AU - Scherr, Douglas

AU - Pini, Giovannalberto

AU - Tan, Wei Shen

AU - Maatman, Thomas J.

AU - Kibel, Adam

AU - Yuh, Bertram

AU - Peak, Taylor C.

PY - 2018/5/5

Y1 - 2018/5/5

N2 - Introduction and Objective This study aims to provide an update and compare perioperative outcomes and complications of Intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following RARC from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC). Methods A retrospective review of 2125 patients from 26 institutions was performed. ICUD was compared with ECUD Multivariate (stepwise variable selection) logistic regression models were fit to evaluate preoperative, operative, and postoperative predictors of receiving ICUD, operative time, high grade complications and 90-days readmissions after RARC. Results 51% (n=1094) patients underwent ICUD in our cohort. ICUD patients demonstrated shorter operative times (357 vs 400 minutes, p<0.001), less blood loss (300 vs 350 ml, p<0.001), and fewer blood transfusions (4% vs 19%, p<0.001). ICUD patients experienced more high grade complications (13 vs 10%, p=0.02). Utilization of ICUD increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after ICUD decreased significantly over time (p<0.001). On multivariable analysis, higher annual cystectomy volume (OR 1.02, 95% CI (1.01-1.03), p<0.002) and year of RARC 2013-2016 (OR 68, 95% CI 44-105, p<0.001) and ASA score <3 (OR 1.75, 95% CI 1.38-2.22, p<0.001) were associated with receiving ICUD. ICUD was associated with shorter operative time (27 minutes, p=0.001). Conclusion Utilization of ICUD has increased over the past decade. Higher annual institutional volume of RARCs was associated with performing ICUD. ICUD was associated with shorter operative times. Although ICUD was associated with higher grade complications compared to ECUD, they decreased over time.

AB - Introduction and Objective This study aims to provide an update and compare perioperative outcomes and complications of Intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following RARC from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC). Methods A retrospective review of 2125 patients from 26 institutions was performed. ICUD was compared with ECUD Multivariate (stepwise variable selection) logistic regression models were fit to evaluate preoperative, operative, and postoperative predictors of receiving ICUD, operative time, high grade complications and 90-days readmissions after RARC. Results 51% (n=1094) patients underwent ICUD in our cohort. ICUD patients demonstrated shorter operative times (357 vs 400 minutes, p<0.001), less blood loss (300 vs 350 ml, p<0.001), and fewer blood transfusions (4% vs 19%, p<0.001). ICUD patients experienced more high grade complications (13 vs 10%, p=0.02). Utilization of ICUD increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after ICUD decreased significantly over time (p<0.001). On multivariable analysis, higher annual cystectomy volume (OR 1.02, 95% CI (1.01-1.03), p<0.002) and year of RARC 2013-2016 (OR 68, 95% CI 44-105, p<0.001) and ASA score <3 (OR 1.75, 95% CI 1.38-2.22, p<0.001) were associated with receiving ICUD. ICUD was associated with shorter operative time (27 minutes, p=0.001). Conclusion Utilization of ICUD has increased over the past decade. Higher annual institutional volume of RARCs was associated with performing ICUD. ICUD was associated with shorter operative times. Although ICUD was associated with higher grade complications compared to ECUD, they decreased over time.

KW - Robot-assisted

KW - cystectomy

KW - outcomes

KW - intracorporeal

KW - diversion

U2 - 10.1016/j.juro.2017.12.045

DO - 10.1016/j.juro.2017.12.045

M3 - Article

SN - 0022-5347

JO - Journal of Urology

JF - Journal of Urology

ER -

Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Abstract

Keywords

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