Kadoriku, Fumiya Tokushima University
Sasaki, Yutaro Tokushima University Tokushima University Educator and Researcher Directory
Fukuta, Kyotaro Tokushima Prefectural Central Hospital
Atagi, Yuichiro Ehime Prefectural Central Hospital
Shiozaki, Keito Tokushima Prefectural Central Hospital
Daizumoto, Kei Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Tomida, Ryotaro Tokushima University
Ueno, Yoshiteru Tokushima University
Kusuhara, Yoshito Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Fukawa, Tomoya Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Yanagihara, Yutaka Ehime Prefectural Central Hospital
Yamaguchi, Kunihisa Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Yamamoto, Yasuyo Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Takahashi, Masayuki Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Yamashi, Sadamu Ehime Prefectural Central Hospital
Kan, Masaharu Ehime Prefectural Central Hospital
Robot-assisted radical cystectomy
Intracorporeal ileal conduit
Background: Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are less invasive than conventional procedures. However, for older patients, cutaneous ureterostomy (CUS) may be preferred because urinary diversion using the intestine has a high incidence of perioperative complications and is highly invasive. The purpose of this study was to demonstrate the safety and efficacy of intracorporeal ileal conduit (ICIC) compared with CUS in patients aged 75 years or older who underwent RARC.
Methods: From October 2014 to December 2021, 82 patients aged 75 years or older who underwent RARC at Tokushima University Hospital, Tokushima Prefectural Central Hospital, or Ehime Prefectural Central Hospital were retrospectively reviewed. Of these, 52 and 25 patients who underwent ICIC and CUS, respectively, were included. After adjusting the patients’ characteristics using propensity score-matching, surgical results and prognoses were retrospectively compared. The propensity score was based on age, Eastern Cooperative Oncology Group Performance Status Scale (ECOG-PS), American Society of Anesthesiologists physical status classification (ASA-PS), clinical tumor stage, and neoadjuvant chemotherapy.
Results: The median age was lower in the ICIC group compared with the CUS group, and the proportion of high-risk cases (ECOG-PS ≥ 2 or ASA-PS ≥ 3) did not differ. The median operation time was longer in the ICIC group, and estimated blood loss was higher, compared with the CUS group. There were no significant differences in the incidence of complications within the first 30 postoperative days, incidence of complications 30–90 days after surgery, 2 year overall survival, 2-year cancer-specific survival, and 2-year recurrence-free survival. The stent-free rate was significantly lower in the CUS group than that in the ICIC group.
Conclusion: In older patients, the ICIC group showed non-inferior surgical and oncological outcomes compared with the CUS group. Urinary diversion following RARC in older patients should be carefully selected by considering not only the age but also the general condition (including comorbidities) of the patient.
BioMed Central|Springer Nature
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