A population-based study of ureteroenteric strictures after open and robot-assisted radical cystectomy Journal Article
| Authors: | Goh, A. C.; Belarmino, A.; Patel, N. A.; Sun, T.; Sedrakyan, A.; Bochner, B. H.; Hu, J. C. |
| Article Title: | A population-based study of ureteroenteric strictures after open and robot-assisted radical cystectomy |
| Abstract: | Objective: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. Methods: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. Results: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). Conclusion: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome. © 2019 Elsevier Inc. |
| Keywords: | controlled study; treatment outcome; aged; aged, 80 and over; retrospective studies; major clinical study; follow up; antineoplastic agent; cancer grading; disease association; tumor volume; incidence; risk factors; retrospective study; bladder tumor; risk factor; urinary bladder neoplasms; postoperative complication; postoperative complications; preoperative period; cystectomy; urinary diversion; ureter stricture; minimally invasive surgery; neoadjuvant chemotherapy; ureter; carcinoma, transitional cell; anastomosis; transitional cell carcinoma; intestine; intestines; anastomosis, surgical; hydronephrosis; ureter obstruction; adverse event; hospital volume; procedures; ureteral obstruction; open surgery; constriction, pathologic; very elderly; humans; human; male; female; priority journal; article; robotic surgical procedure; robotic surgical procedures; robot assisted surgery; adverse device effect; stenosis, occlusion and obstruction; ureteroenteric stricture |
| Journal Title: | Urology |
| Volume: | 135 |
| ISSN: | 0090-4295 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2020-01-01 |
| Start Page: | 57 |
| End Page: | 64 |
| Language: | English |
| DOI: | 10.1016/j.urology.2019.07.054 |
| PUBMED: | 31618656 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work