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A comparative propensity score-matched analysis of perioperative outcomes of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
Hussein, Ahmed A; Elsayed, Ahmed S; Aldhaam, Naif A; Jing, Zhe; Peabody, James O; Wijburg, Carl J; Wagner, Andrew; Canda, Abdullah Erdem; Khan, Mohammad Shamim; Scherr, Douglas; Schanne, Francis; Maatman, Thomas J; Kim, Eric; Mottrie, Alexandre; Aboumohamed, Ahmed; Gaboardi, Franco; Pini, Giovannalberto; Kaouk, Jihad; Yuh, Bertram; Rha, Koon-Ho; Hemal, Ashok; Palou Redorta, Joan; Badani, Ketan; Saar, Matthias; Stockle, Michael; Richstone, Lee; Roupret, Morgan; Balbay, Derya; Dasgupta, Prokar; Menon, Mani; Guru, Khurshid A.
Afiliação
  • Hussein AA; Roswell Park Cancer Institute, Buffalo, NY, USA.
  • Elsayed AS; Roswell Park Cancer Institute, Buffalo, NY, USA.
  • Aldhaam NA; Roswell Park Cancer Institute, Buffalo, NY, USA.
  • Jing Z; Roswell Park Cancer Institute, Buffalo, NY, USA.
  • Peabody JO; Henry Ford Health System, Detroit, MI, USA.
  • Wijburg CJ; Rijnstate Hospital, Arnhem, The Netherlands.
  • Wagner A; Beth Israel Deaconess Medical Center, Boston, MA, USA.
  • Canda AE; Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey.
  • Khan MS; Guy's Hospital and King's College London School of Medicine, London, UK.
  • Scherr D; Weill Cornell Medical Center, New York, NY, USA.
  • Schanne F; Urological Surgical Associates of Delaware, Wilmington, DE, USA.
  • Maatman TJ; Metro Health Hospital, Michigan State University, East Lansing, MI, USA.
  • Kim E; Washington University, St. Louis, MO, USA.
  • Mottrie A; Onze-Lieve-Vrouw Ziekenhuis, Aalast, Belgium.
  • Aboumohamed A; Montefiore Medical Center, The Albert Einstein College of Medicine, New York, NY, USA.
  • Gaboardi F; San Raffaele Turro Hospital, Milan, Italy.
  • Pini G; San Raffaele Turro Hospital, Milan, Italy.
  • Kaouk J; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Yuh B; City of Hope and Beckman Research Institute, Duarte, CA, USA.
  • Rha KH; Department of Urology, Yonsei University Health System Severance Hospital, Seoul, Korea.
  • Hemal A; Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
  • Palou Redorta J; Fundacio Puigvert, Barcelona, Spain.
  • Badani K; Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
  • Saar M; University of the Saarland, Homburg Saar, Germany.
  • Stockle M; University of the Saarland, Homburg Saar, Germany.
  • Richstone L; The Arthur Smith Institute for Urology, New Hyde Park, NY, USA.
  • Roupret M; Pitie Salpetriere Academic Hospital, Sorbonne University, Paris, France.
  • Balbay D; Koç University Hospital, Istanbul, Turkey.
  • Dasgupta P; Guy's Hospital and King's College London School of Medicine, London, UK.
  • Menon M; Henry Ford Health System, Detroit, MI, USA.
  • Guru KA; Roswell Park Cancer Institute, Buffalo, NY, USA.
BJU Int ; 126(2): 265-272, 2020 08.
Article em En | MEDLINE | ID: mdl-32306494
OBJECTIVE: To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC). PATIENTS AND METHODS: We retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions who underwent RARC were included. Propensity score matching was used to match patients based on age, gender, body mass index (BMI), American Society of Anesthesiologists Score (ASA) score, Charlson Comorbidity Index (CCI) score, prior radiation and abdominal surgery, receipt of neoadjuvant chemotherapy, and clinical staging. Matched cohorts were compared. Multivariate stepwise logistic and linear regression models were fit to evaluate variables associated with receiving ICUD, operating time, 90-day high-grade complications (Clavien-Dindo Classification Grade ≥III), and 90-day readmissions after RARC. RESULTS: Utilisation of ICUD increased from 0% in 2005 to 95% in 2018. The ICUD patients had more overall complications (66% vs 58%, P = 0.01) and readmissions (27% vs 17%, P = 0.01), but not high-grade complications (21% vs 24%, P = 0.22). A more recent RC era and ileal conduit diversion were associated with receiving an ICUD. Higher BMI, ASA score ≥3, and receiving a neobladder were associated with longer operating times. Shorter operating time was associated with male gender, older age, ICUD, and centres with a larger annual average RC volume. Longer intensive care unit stay was associated with 90-day high-grade complications. Higher CCI score, prior radiation therapy, neoadjuvant chemotherapy, and ICUD were associated with a higher risk of 90-day readmissions. CONCLUSIONS: Utilisation of ICUD has increased over the past decade. ICUD was associated with more overall complications and readmissions compared to ECUD, but not high-grade complications.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Derivação Urinária / Neoplasias da Bexiga Urinária / Cistectomia / Procedimentos Cirúrgicos Robóticos Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Derivação Urinária / Neoplasias da Bexiga Urinária / Cistectomia / Procedimentos Cirúrgicos Robóticos Idioma: En Ano de publicação: 2020 Tipo de documento: Article