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 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
