Oncologic outcomes of intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy: a multi-institutional Korean study.

BACKGROUND We aimed to compare the oncologic outcomes of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) in patients diagnosed with bladder cancer. MATERIALS AND METHODS Medical records of 730 patients who underwent RARC between April 2007 and May 2019 in 11 tertiary referral centers were retrospectively reviewed. We assessed recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in the two groups using the Kaplan-Meier method. Cox regression models were used to identify factors associated with RFS, CSS, and OS. RESULTS Among 591 patients neobladder diversion was performed more frequently in the ICUD group (70.8% vs 52.5%, P=0.001). The median follow-up duration was shorter in the ICUD group than in the ECUD group (16 vs 26 months, P<0.001). The rates of overall recurrence (36.5% vs 25.5%, P=0.013) and pelvic recurrence (12.1% vs 5.9%, P=0.031) were higher in the ECUD group. However, no differences in 5-year RFS (43.2% vs 58.4%, P=0.516), CSS (79.3% vs 89.7%, P=0.392), and OS (74.3% vs 81.4%, P=0.411) were noted between the two groups. Multivariable analysis revealed that when compared to ICUD, ECUD was not associated with RFS (hazard ratio [HR], 0.982; P=0.920), CSS (HR, 0.568; P=0.126), and OS (HR, 0.642; P=0.124). CONCLUSION Although there was a difference in recurrence rate between the two groups, multivariable analysis indicated that the diversion technique after RARC did not affect the oncologic outcomes. Large prospective studies with long-term follow-up are warranted to verify the oncologic outcomes of ICUD and ECUD following RARC.