Perioperative outcomes of intracorporeal versus extracorporeal urinary diversion following robot-assisted radical cystectomy in multicenter KORARC database

PURPOSE: To compare perioperative outcomes of intracorporeal (ICUD) versus extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) in localized bladder cancer, using the Korean RARC (KORARC) Study Group database. METHODS: Patient characteristics, intraoperative details, and perioperative outcomes were compared between ICUD and ECUD groups. The primary outcome was postoperative complications; secondary outcomes were operative time, hospital stay, estimated blood loss (EBL), and transfusion rate. Multivariate regression adjusted for potential confounders, and subgroup analyses stratified by urinary diversion type were performed. RESULTS: Of 703 patients undergoing RARC between 2007 and 2019, 26.5% had ICUD and 73.5% had ECUD. Overall complication rates were similar (52.7% vs. 60.0%, p = 0.101), but ICUD showed fewer late complications (30-90 days; 30.1% vs. 38.9%, p = 0.041) and longer operative time (494.6 ± 120.6 vs. 417.9 ± 136.6 min, p < 0.001). On multivariate analysis, ICUD was independently associated with reduced late complications (Odds ratio [OR] 0.68, 95% confidence interval [CI]: 0.47-0.97, p = 0.034), without affecting minor, major, or overall complication risks. In diversion-stratified analyses, ICUD required longer operative time in both ileal conduit (514.6 vs. 453.8 min, p < 0.001) and neobladder (470.6 vs. 405.6 min, p < 0.001) subgroups. EBL was higher with ICUD in the ileal conduit subgroup (p = 0.034) but lower in the neobladder subgroup (p = 0.003). The protective effect on late complications was confined to the ileal conduit subgroup (adjusted OR 0.60, 95% CI 0.38-0.95, p = 0.029) and not observed in the neobladder subgroup (OR 0.76, p = 0.462). CONCLUSION: Although associated with longer operative time, ICUD may reduce late postoperative complications compared with ECUD without compromising perioperative safety or oncological outcomes after RARC.