Perioperative and Functional Outcomes of Robot-assisted Ureteroenteric Reimplantation : A Multicenter Study of Seven Referral Institutions
Carrion, Albert (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Hussein, Ahmed Aly (Roswell Park Comprehensive Cancer Center. Department of Urology)
Eun, Daniel (Temple University. Department of Urology)
Hosseini, Abolfazl (Karolinska University Hospital and Karolinska Institutet (Suècia))
Gaya, Josep Maria (Universitat Autònoma de Barcelona)
Abaza, Ronney (Ohio Health Dublin Methodist Hospital. Department of Urology)
Bonet, Xavier (Institut d'Investigació Biomèdica de Bellvitge)
Iqbal, Umar (Roswell Park Comprehensive Cancer Center. Department of Urology)
Lee, Randall A. (Temple University. Department of Urology)
Lee, Ziho (University of Washington (Seattle). Department of Urology)
Lee, Matthew (Temple University. Department of Urology)
Raventos, Carles (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Moreno, Oriol (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Palou, Juan (Universitat Autònoma de Barcelona)
Breda, Alberto (Universitat Autònoma de Barcelona)
Lozano, Fernando (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Vigués, Francesc (Institut d'Investigació Biomèdica de Bellvitge)
Trilla Herrera, Enrique (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Guru, Khurshid A. (Roswell Park Comprehensive Cancer Center. Department of Urology)

Fecha:	2022
Resumen:	This is the first multicenter study in the literature that specifically investigates the feasibility of robot-assisted ureteroenteric reimplantation for the management of ureteroenteric strictures. This minimally invasive procedure is feasible and could be an alternative to open revisions. Open revision of ureteroenteric strictures (UESs) is associated with considerable morbidity. There is a lack of data evaluating the feasibility of robotic revisions. To analyze the perioperative and functional outcomes of robot-assisted ureteroenteric reimplantation (RUER) for the management of UESs after radical cystectomy (RC). A retrospective multicenter study of 61 patients, who underwent 63 RUERs at seven high-volume institutions between 2009 and 2020 for benign UESs after RC, was conducted. Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Variables associated with being stricture free after an RUER were evaluated using a multivariate Cox regression analysis. Among 63 RUERs, 22 were right sided (35%), 34 left sided (54%), and seven bilateral (11%). Twenty-seven (44%) had prior abdominal/pelvic surgery and five (8%) radiotherapy (RT). Thirty-two patients had American Society of Anesthesiologists (ASA) scores I-II (52%) and 29 ASA III (48%). Forty-two (68%) RUERs were in ileal conduits, 18 (29%) in neobladders, and two (3%) in Indiana pouch. The median time to diagnosis of a UES from cystectomy was 5 (3-11) mo. Of the UESs, 28 (44%) failed an endourological attempt (balloon dilatation/endoureterotomy). The median RUER operative time was 195 (175-269) min. No intraoperative complications or conversions to open approach were reported. Twenty-three (37%) patients had postoperative complications (20 [32%] were minor and three [5%] major). The median length of hospital stay was 3 (1-6) d and readmissions were 5%. After a median follow-up of 19 (8-43) mo, 84% of cases were stricture free. Lack of prior RT was the only variable associated with better stricture-free survival after RUER (hazard ratio 6. 8, 95% confidence interval 1. 10-42. 00, p = 0. 037). The study limitations include its retrospective nature and the small number of patients. RUER is a feasible procedure for the management of UESs. Prospective and larger studies are warranted to prove the safety and efficacy of this technique. In this study, we investigate the feasibility of a novel minimally invasive technique for the management of ureteroenteric strictures. We conclude that robotic reimplantation is a feasible and effective procedure.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Robot-assisted ureteroenteric reimplantation ; Ureteroenteric stricture ; Radical cystectomy ; Postoperative complications ; Bladder cancer
Publicado en:	European Urology Open Science, Vol. 35 (january 2022) , p. 47-53, ISSN 2666-1683

DOI: 10.1016/j.euros.2021.11.005
PMID: 35024631

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