Robot-assisted radical cystectomy (RARC) has gained traction in the management of muscle invasive bladder cancer. Urinary diversion for RARC was achieved with orthotopic neobladder and ileal conduit. Evidence on the optimal method of urinary diversion was limited. Long-term outcomes were not reported before. This study was designed to compare the perioperative and oncological outcomes of ileal conduit versus orthotopic neobladder cases of nonmetastatic bladder cancer treated with RARC.
The Asian RARC consortium was a multicenter registry involving nine Asian centers. Consecutive patients receiving RARC were included. Cases were divided into the ileal conduit and neobladder groups. Background characteristics, operative details, perioperative outcomes, recurrence information, and survival outcomes were reviewed and compared. Primary outcomes include disease-free and overall survival. Secondary outcomes were perioperative results. Multivariate regression analyses were performed.
From 2007 to 2020, 521 patients who underwent radical cystectomy were analyzed. Overall, 314 (60.3%) had ileal conduit and 207 (39.7%) had neobladder. The use of neobladder was found to be protective in terms of disease-free survival [Hazard ratio (HR) = 0.870, p = 0.037] and overall survival (HR = 0.670, p = 0.044) compared with ileal conduit. The difference became statistically nonsignificant after being adjusted in multivariate cox-regression analysis. Moreover, neobladder reconstruction was not associated with increased blood loss, nor additional risk of major complications.
Orthotopic neobladder urinary diversion is not inferior to ileal conduit in terms of perioperative safety profile and long-term oncological outcomes. Further prospective studies are warranted for further investigation.
Annals of surgical oncology. 2024 May 27 [Epub ahead of print]
Chris Ho-Ming Wong, Ivan Ching-Ho Ko, Seok Ho Kang, Kousuke Kitamura, Shigeo Horie, Satoru Muto, Chikara Ohyama, Shingo Hatakeyama, Manish Patel, Cheung-Kuang Yang, Kittinut Kijvikai, Lee Ji Youl, Hai-Ge Chen, Rui-Yun Zhang, Tian-Xin Lin, Lui Shiong Lee, Jeremy Yuen-Chun Teoh, Eddie Chan
S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China., Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea., Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan., Department of Urology, Hirosaki University, Hirosaki, Japan., Department of Urology, The University of Sydney, Sydney, Australia., Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan., Department of Urology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand., Department of Urology, Catholic University of Korea, Seoul, Republic of Korea., Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China., Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China., Department of Urology, Sengkang General Hospital, Singapore, Singapore., S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China. .