Comparison of perioperative outcomes and complications between intracorporeal, extracorporeal, and hybrid ileal conduit urinary diversion during robot-assisted radical cystectomy: A comparative propensity score-matched analysis from nationwide multi-institutional study in Japan

Abstract Background To investigate the impact of different urinary diversion (UD) techniques on the peri- and postoperative complications of robot-assisted radical cystectomy (RARC) with ileal conduit. Methods We retrospectively analyzed 373 patients undergoing RARC with ileal conduit at 11 institutions in Japan between April 2018 and December 2021. Propensity score weighting was performed to adjust for confounding factors such as age, sex, body mass index, performance status, American Society of Anesthesiologists score, previous abdominal surgery, neoadjuvant chemotherapy, and preoperative high T stage (≥ cT3) and high N stage (≥ cN1). Perioperative complications were then compared among three groups: extracorporeal, intracorporeal, and hybrid urinary diversion (ECUD, ICUD, and HUD, respectively). Results A total of 150, 68, and 155 patients received ECUD, HUD, and ICUD, respectively. Bowel reconstruction time and UD time were significantly shorter in the ECUD group (p < 0.001), and urethrectomy and extended lymph node dissection were significantly performed in the HUD group (p < 0.001). For postoperative complications (Clavien–Dindo Classification grade ≥ 3) within 90 days, surgical site infection (p = 0.004), pelvic abscess (p = 0.013), and anastomotic urine leak (p = 0.007) significantly occurred in the ECUD group. For late complications (grade ≥ 3, after 90 days), pelvic organ prolapse was significantly more common in the ECUD group (p = 0.011). Conclusions Although postoperative complications such as infection, uretero-conduit anastomosis–related events, and pelvic organ prolapse were more common in the ECUD group, HUD and ICUD can be safely performed during RARC.