Uretero-enteric stricture outcomes: Secondary analysis of a randomised controlled trial comparing open versus robot-assisted radical cystectomy Journal Article

Authors: Huang, C.; Assel, M.; Beech, B. B.; Benfante, N. E.; Sjoberg, D. D.; Touijer, A.; Coleman, J. A.; Dalbagni, G.; Herr, H. W.; Donat, S. M.; Laudone, V. P.; Vickers, A. J.; Bochner, B. H.; Goh, A. C.
Article Title: Uretero-enteric stricture outcomes: Secondary analysis of a randomised controlled trial comparing open versus robot-assisted radical cystectomy
Abstract: Objectives: To analyse the risk of uretero-enteric anastomotic stricture in patients randomised to open (ORC) or robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion. Patients and Methods: We included 118 patients randomised to RARC (n = 60) or ORC (n = 58) at a single, high-volume institution from March 2010 to April 2013. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher's exact test. Results: In all, 58 and 60 patients were randomised to RARC and ORC, respectively. We identified five strictures, all in the ORC group. In patients with ≥1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% confidence interval 1.5%, 17%). Of the five strictures, three were managed endoscopically while two required open revision. There was no evidence that perioperative Grade 3–5 complications were associated with development of a stricture (P = 1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (P = 0.15). Conclusions: In this study at a high-volume centre, RARC with extracorporeal urinary diversion achieved excellent ureteric anastomotic outcomes. Purported increased risk of stricture is not a reason to avoid RARC. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed. © 2022 BJU International.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; human cell; major clinical study; clinical feature; follow up; randomized controlled trial; pathology; diagnostic imaging; bladder tumor; urinary bladder neoplasms; postoperative complication; postoperative complications; confidence interval; cystectomy; urinary diversion; endoscopic surgery; ureter stricture; robotics; randomization; fisher exact test; ureter obstruction; post hoc analysis; adverse event; health hazard; clinical outcome; procedures; open surgery; constriction, pathologic; estimated glomerular filtration rate; humans; human; female; article; robot-assisted radical cystectomy; robotic surgical procedures; robot assisted surgery; adverse device effect; stenosis, occlusion and obstruction; open radical cystectomy; #bladdercancer; #uroonc; #blcsm; ureteric stricture; uretero enteric stricture
Journal Title: BJU International
Volume: 130
Issue: 6
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2022-12-01
Start Page: 809
End Page: 814
Language: English
DOI: 10.1111/bju.15825
PUBMED: 35694836
PROVIDER: scopus
Notes: Article -- Export Date: 1 December 2022 -- Source: Scopus
Citation Impact
MSK Authors
  1. Jonathan Coleman
    294 Coleman
  2. Vincent Laudone
    106 Laudone
  3. Guido Dalbagni
    310 Dalbagni
  4. Sherri M Donat
    158 Donat
  5. Andrew J Vickers
    747 Vickers
  6. Daniel D. Sjoberg
    215 Sjoberg
  7. Bernard Bochner
    421 Bochner
  8. Harry W Herr
    577 Herr
  9. Nicole E Benfante
    116 Benfante
  10. Alvin Chun chin Goh
    44 Goh
  11. Chun Huang
    8 Huang
  12. Benjamin Buckler Beech
    2 Beech