Intracorporeal versus extracorporeal urinary diversion during robotic radical cystectomy: outcomes from a large single-institutional study

Abstract

BACKGROUND: Over the past decade, there has been a significant increase in the use of robot-assisted radical cystectomy (RARC) with fully intracorporeal urinary diversion. Utilizing data from a single, high-volume institutional database, this study aimed to evaluate and compare perioperative outcomes and complications associated with intracorporeal urinary diversion (ICUD) versus extracorporeal urinary diversion (ECUD) following RARC. METHODS: This study included 405 patients with bladder cancer who underwent RARC at our institution between July 2016 and April 2023. Data were retrospectively reviewed and compared between ICUD and ECUD groups. The 90-day major complications (MC90), 90-day overall complications (OC90), and perioperative and pathological outcomes were evaluated. Statistical analyses were performed using the Pearson chi-square test, Mann-Whitney U test, Kaplan-Meier tests, and multivariable regression analysis. RESULTS: Following RARC, 230 patients underwent ICUD and 175 underwent ECUD. No significant differences in demographics or oncological characteristics were observed between the two groups, except for a higher proportion of females in the ICUD group. Notably, ICUD was associated with significantly reduced median operative time (319 min vs. 370 min, p < 0.01) and lower median estimated blood loss (300 ml vs. 500 ml, p < 0.01). Postoperative recovery was faster in the ICUD group. However, the OC90, MC90, overall survival, and recurrence-free survival were comparable between the two groups. CONCLUSIONS: Compared with ECUD, ICUD significantly improved perioperative outcomes, including operative time, estimated blood loss, and postoperative recovery, without compromising long-term oncological survival or complication rates.