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. 2024 Oct 27;18(5):15579883241274866. doi: 10.1177/15579883241274866

Comparison of Extracorporeal and Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy for Bladder Cancer: A Meta-Analysis

Shuhui An 1, Lei Shi 1, Yuepeng Liu 1, Lixin Ren 1, Kun Zhang 1, Meng Zhu 1,✉
PMCID: PMC11526166  PMID: 39462910

Abstract

To explore the therapeutic efficacy of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy for bladder cancer through systematic review. This study systematically retrieved electronic databases of PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang to include peer-reviewed studies comparing ICUD and ECUD after robot-assisted radical cystectomy for bladder cancer. Relative risk (RR) and mean difference (MD) were used to represent the pooled effect size and estimate its 95% confidence interval (CI). This study included 15 studies with good quality, involving 5,370 patients undergoing robot-assisted radical cystectomy for bladder cancer. Meta-analysis showed that ICUD reduced intraoperative bleeding volume by 64.12 ml (95% confidence interval [CI]: [−100.95, −27.29]), significantly decreased the risk of blood transfusion (RR: 0.40; 95% CI: [0.24, 0.68]) and gastrointestinal complications (odds ratio [OR]: 0.61; 95% CI: [0.47, 0.80]), with shorter postoperative time of exhaust (MD: −9.27; 95% CI: [−18.47, −0.08]) and oral intake (MD: −0.92; 95% CI: [−1.30, −0.54]). However, ICUD had a relatively longer surgical duration (MD: 30.84 min, 95% CI: [5.03, 56.66]). In addition, there was no statistically significant difference concerning the impact of ICUD and ECUD on the length of stay in the hospital (MD: −0.68d; 95% CI: [−1.79, 0.42]), overall complications (30-day: RR: 1.16; 95% CI: [0.93, 1.46]; and 90-day, RR: 0.85; 95% CI: [0.69, 1.04]) and readmission rate (30-day: RR: 0.96; 95% CI: [0.72, 1.27]; and 90-day: RR: 1.15; 95% CI: [0.80, 1.64]). ICUD after robot-assisted laparoscopic radical cystectomy for bladder cancer exhibits obvious positive effects, especially in reducing the risk of blood transfusion and gastrointestinal complications, and shortening postoperative time of exhaust and oral intake. The findings in this meta-analysis should be confirmed by multiple high-quality studies in the future.

Keywords: bladder cancer, robotic-assisted, intracorporeal urinary diversion, extracorporeal urinary diversion, meta-analysis

Introduction

Bladder cancer is one of the most common cancers in the world according to existing epidemiological surveys. It was estimated that there would be over 573,000 new cases of bladder cancer diagnosed in 2020 and about 212,000 deaths as a result of this disease worldwide (Wéber et al., 2024). The treatment of bladder cancer is of great significance in improving the prognosis of patients. Open radical cystectomy combined with pelvic lymphadenectomy is considered to be an important therapeutic option for muscle-invasive bladder cancer or high-risk non-muscle-invasive bladder cancer (Tong et al., 2019). However, open surgery may be accompanied by higher rates of postoperative complications and mortality (Su et al., 2019). Robot-assisted radical cystectomy has gradually become the mainstream option for bladder cancer along with the advancement of medical technology and good prognosis. The proportion of robot-assisted radical cystectomy in the United States increased from 0.6% in 2004 to 18.5% in 2012 (Hu et al., 2016).

The impact of urinary diversion on the morbidity of postoperative complications may be greater than that of cystectomy itself in patients undergoing radical cystectomy (Taber et al., 2024). Considering the complexity of surgery, extracorporeal urinary diversion (ECUD) is the preferred therapeutic option. While intracorporeal urinary diversion (ICUD) exhibits the advantages of small incisions and rapid recovery (Wilson et al., 2015). However, it requires a longer learning curve that may be a critical factor for its clinical application (Dell’Oglio et al., 2021). Despite this, robot-assisted radical cystectomy combined with ICUD, as an alternative to ECUD, is increasingly being widely used clinically. There have been reports on perioperative outcomes of ICUD and ECUD after robot-assisted radical cystectomy (Feng et al., 2020), yet with the absence of the latest large-scale studies (Dalimov et al., 2022; Morizane et al., 2024). Therefore, we conducted a systematic evaluation and meta-analysis by involving the latest reports to compare the efficacy of ICUD and ECUD in patients undergoing robot-assisted radical cystectomy to offer reliable evidence-based data for clinical practice.

Materials and Method

Retrieval Strategy

According to the PRISMA2020 statement (Page et al., 2021), a systematic retrieval was conducted on articles published in 5 relevant electronic databases in Chinese and English, including PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang, from database inception to April 10, 2024. When searching English databases, the following retrieval strategy was applied: “bladder cancer,”“radical cystectomy”; “robotic assisted”; “urinary diversion,”“intracorporeal,” and “extracorporeal.” The retrieval was performed in Boolean operator fuzzy logic. Similar search terms were used for literature retrieval in Chinese databases. Furthermore, eligible articles were screened by reviewing the included literature and relevant references.

Inclusion and Exclusion Criteria

Inclusion criteria: (a) Chinese and English studies published in peer-reviewed journals; (b) studies performed with the inclusion of patients with muscle-invasive bladder cancer or high-risk non-muscle-invasive bladder cancer undergoing robot-assisted radical cystectomy; (c) studies with the establishment of an observation group applying ICUD; (d) studies with the establishment of a control group using ECUD; and (e) randomized controlled trials, cohort studies, or case-control studies.

Exclusion criteria: (a) studies performed with the inclusion of patients with other serious urinary system diseases or comorbidities, such as renal insufficiency, hematuria, and urinary system infections; (b) studies performed with the inclusion of patients who underwent cystectomy previously; and (c) studies with the lack of data for analysis.

Literature Screening and Data Extraction

Two researchers independently conducted literature screening. Disagreements between reviewers would be resolved by additional screening of the reference by a third researcher. Data extraction was completed using the standard data extraction table developed by the research team. The main data extracted were basic literature information (first author, publication time, and region), study design (type, sample size, study duration, and outcome endpoints), study population (mean age, percentage of male, %), intervention measures (urinary diversion methods), research results (surgical duration, intraoperative bleeding volume, blood transfusion rate, length of stay in the hospital, incidence of complications, and readmission rate).

Literature Quality Evaluation

We used the Newcastle-Ottawa Scale (NOS; Stang, 2010) to evaluate the quality of the included literature. Each study was scored in three categories–selection, comparability, and outcome. The maximum score of NOS was 9 points, and the study with a score of ≥7 points was considered high quality.

Statistical Analysis

Reman5.3 software was used for data analysis. The relative risk (RR) and mean difference (MD) were used to express the effect size of counting data and measurement data, respectively, and the 95% confidence interval (CI) was utilized to estimate the interval range of the effect size. Heterogeneity testing was performed using Cochran’s Q-tests and I2 statistics to determine the presence and magnitude of heterogeneity. The estimate from a random-effects meta-analysis is more conservative than that from a fixed-effect meta-analysis; hence, we used a conservative model to address the potential differences in effects across studies and populations (DerSimonian & Laird, 1986; Higgins & Altman, 2008). Measurement data with zero events was estimated using the Peto model, and the pooled effect size using the ratio estimation method (Xu et al., 2021). Subgroup analyses of complications and readmission risk were further conducted based on the time of evaluation. A sensitivity analysis was performed to evaluate potential sources of heterogeneity by excluding each study from the pooled estimate. Unless otherwise specified, the inspection level was set at 0.05.

Results

Literature Screening, Basic Characteristics of the Included Studies and Results of Literature Quality Evaluation

Searching in public electronic databases included 1,392 studies during the literature review, as shown in Figure 1. A total of 317 articles were included during the full-text review after excluding 411 duplicates and 664 unrelated studies. Finally, 15 eligible studies were included according to the inclusion and exclusion criteria pre-set in this study (Ahmed et al., 2014; Bertolo et al., 2019; Dalimov et al., 2022; Guru et al., 2010; Hussein et al., 2018; Kang et al., 2012; Kingo et al., 2017; Lenfant et al., 2018; Mistretta et al., 2021; Morizane et al., 2024; Pruthi et al., 2010; Pyun et al., 2016; Shim et al., 2020; Tan et al., 2019; Teoh et al., 2021).

Figure 1.

Figure 1.

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Literature Screening Flow Diagram

Table 1 shows the baseline characteristics of the included studies. The included 15 studies conducted mainly from 2003 to 2021, were published from 2010 to 2024. Eight articles were multicenter studies, and 3 were prospective cohort studies. Furthermore, there were 5,370 patients undergoing robot-assisted radical cystectomy for bladder cancer among the 15 studies, 2,414 of whom received ICUD, and 2,956 used ICUD. The enrolled subjects of the study were older in age, with an average age of 60 years old, and the majority were males. In addition, the evaluation of literature quality revealed that the included studies had good quality (mean NOS: 7.53).

Table 1.

Characteristics of Eligible Studies and Results of Quality Assessment

Study Location Study design Study period Mean age
(ICUD/ECUD)		 Male%
(ICUD/ECUD)		 Mean BMI
(ICUD/ECUD)		 UD type Sample size
(ICUD/ECUD)		 NOS
Pruthi,2010 The United States single-center,
retrospective cohort		 2008-2009 60.9/66.9 75/70 27.6/27.4 ileal conduit:22
neobladder:10		 12/20 8
Guru,2010 The United States single-center,
retrospective cohort		 2005-2009 71/66 84.61/69.23 - ileal conduit:26 13/13 8
Kang,2012 Korea single-center,
retrospective cohort		 2007-2011 69.5/62.2 75/92.11 26.4/24.8 ileal conduit:25
neobladder:15		 4/38 7
Ahmed,2014 The United Kingdom multi-center,
retrospective cohort		 2003-2011 66/68 80/81 28/27 ileal conduit:676
neobladder:259		 167/768 8
Pyun,2016 Korea single-center,
retrospective cohort		 2007-2014 65.4/63.1 92.3/92.2 24.8/24.9 ileal conduit:38
neobladder:26		 26/38 7
Kingo,2017 Denmark single-center,
prospective cohort		 2012-2015 68.26/68.12 81.6/83 27.34/24.32 ileal conduit:50 38/12 7
Hussein,2018 The United States multi-center,
retrospective cohort		 2005-2016 67/68 71/81 27.3/27.5 ileal conduit:1658
neobladder:467		 1094/1031 8
Lenfant,2018 French multi-center,
retrospective cohort		 2010-2016 65/68 81.1/94.1 25.9/26.2 ileal conduit:63
neobladder:45		 74/34 7
Tan,2019 The United Kingdom single-center,
retrospective cohort		 2015-2017 71/69 79.0/85.7 26.5/27.0 ileal conduit:127 59/68 8
Bertolo,2019 The United States multi-center,
prospective cohort		 2014-2017 69/73 82.1/83 - ileal conduit:126 60/66 8
Shim,2020 Korea multi-center,
prospective cohort		 2007-2017 64.4/65.3 85.7/85.6 24.2/23.7 ileal conduit:141
neobladder:221		 84/278 7
Mistretta,2021 Italy single-center,
retrospective cohort		 2014-2019 60/62 - 26.9/26.6 neobladder:101 57/44 7
Teoh,2021 China multi-center,
retrospective cohort		 2007-2020 66.86/68.17 84.7/89.2 24.47/24/32 ileal conduit:315
neobladder:213		 307/249 7
Dalimov,2022 Sweden multi-center,
retrospective cohort		 2003-2020 61/57 87/84 27.1/27.1 neobladder:411 264/147 8
Morizane,2024 Japan multi-center,
retrospective cohort		 2018-2021 71.4/71.1 77.5/79.5 22.6/22.8 neobladder:305 155/150 8
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Note. ICUD, Intracorporeal Urinary Diversion; ECUD, Extracorporeal Urinary Diversion; UD, Urinary Diversion; NOS, Newcastle-Ottawa Scale; BMI, body mass index.

Surgical Duration

Thirteen studies reported surgical duration for ICUD and ECUD, involving a total of 4,130 patients (ICUD: n=2,092, ECUD: n=2,038). The meta-analysis based on a random-effects model (Figure 2) showed that the surgical duration of patients with ICUD was 30.84 min longer than that of ECUD (95% CI: [5.03, 56.66]). The heterogeneity testing results revealed heterogeneity among the included studies (I2 = 99%, p < .00001). Meanwhile, sensitivity analysis revealed no significant reduction in heterogeneity after excluding any one of the included studies, without any change in the result of the pooled estimate.

Figure 2.

Figure 2.

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Meta-Analysis for the Comparison of Surgical Duration (min) Between ICUD and ECUD

Intraoperative Bleeding Volume

Intraoperative bleeding outcomes for ICUD and ECUD were reported in 12 studies, involving a total of 3,662 patients (ICUD: n=1,899, ECUD: n=1,763). The pooled effect size calculated based on the random-effects model (Figure 3) showed that compared with ECUD, ICUD reduced intraoperative bleeding volume by approximately 64.12 ml (95% CI: [−100.95, −27.29]). The heterogeneity testing results revealed heterogeneity among the included studies (I2 = 90%, p<.00001). Sensitivity analysis revealed no significant reduction in heterogeneity after excluding any one of the included studies, without any change in the result of the pooled estimate.

Figure 3.

Figure 3.

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Meta-Analysis for the Comparison of Intraoperative Bleeding Volume (ml) Between ICUD and ECUD

Blood Transfusion Rate

Eight studies were related to blood transfusion rates for ICUD and ECUD, involving 3,602 patients in totally (ICUD: n=1,814, ECUD: n=1,788). The meta-analysis based on the random-effects model (Figure 4) indicated that the transfusion risk of ICUD patients was significantly lower than that of ECUD patients (RR: 0.40; 95% CI: [0.24, 0.68]). Heterogeneity among the included studies was observed in the heterogeneity testing (I2 = 72%, p=.0007). No significant reduction in heterogeneity was found in sensitivity analysis after excluding any one of the included studies, without any change in the result of the pooled estimate.

Figure 4.

Figure 4.

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Meta-Analysis for the Comparison of Blood Transfusion Rate Between ICUD and ECUD

Length of Stay in the Hospital

Data related to the length of stay for ICUD and ECUD in the hospital was documented in 13 studies, with 5,312 patients included in total (ICUD: n=2,389, ECUD: n=2,923). The meta-analysis based on the random-effects model (Figure 5) showed no statistically significant difference in the length of stay between ICUD and ECUD (MD: −0.68; 95% CI: [−1.79, 0.42]). Heterogeneity among the included studies was observed in the heterogeneity testing (I2 = 97%, p<.00001). Sensitivity analysis revealed no significant reduction in heterogeneity after excluding any one of the included studies, without any change in the result of the pooled estimate.

Figure 5.

Figure 5.

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Meta-Analysis for the Comparison of the Length of Stay in the Hospital (d) Between ICUD and ECUD

Time of Exhaust and Oral Intake

This study also compared the effects of ICUD and ECUD on postoperative time of oral intake and exhaust in patients. The meta-analysis based on random-effects model revealed that patients undergoing ICUD showed advanced time of oral intake (MD: −0.92; 95% CI: [−1.30, −0.54]; Figure 6) and exhaust (MD: −9.27; 95% CI: [−18.47, −0.08]; Figure 7). Besides, the heterogeneity testing suggested good homogeneity.

Figure 6.

Figure 6.

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Meta-Analysis for the Comparison of the Time of Oral Intake (d) Between ICUD and ECUD

Figure 7.

Figure 7.

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Meta-Analysis for the Comparison of the Time of Exhaust (h) Between ICUD and ECUD

Complications

Nine and eight studies reported the 30-day and 90-day risk of complications for ICUD and ECUD, respectively. The meta-analysis based on the random-effects model (Figure 8) revealed no statistically significant difference in the 30-day (RR: 1.16; 95% CI: [0.93, 1.46]) and 90-day (RR: 0.85; 95% CI: [0.69, 1.04]) complication risks between ICUD and ECUD. There existed heterogeneity among the included studies according to the heterogeneity testing (30-day complications: I2 = 81%; 90-day complications: I2 = 64%; overall: I2 = 80%). After excluding one study (Ahmed et al., 2014), the heterogeneity of the 90-day complication subgroup decreased to 23%, with a pooled effect size of 0.79 (95% CI: [0.67, 0.92]).

Figure 8.

Figure 8.

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Meta-Analysis for the Comparison of Complications (30-Day and 90-Day) Between ICUD and ECUD

In addition, 7 studies provided data on the gastrointestinal complications of ICUD and ECUD, involving 2,504 patients. Considering the presence of zero event in one study (Pyun et al., 2016), the pooled effect size was estimated using odd ratio [OR] calculated based on the Peto model. Corresponding meta-analysis (Figure 9) revealed that the risk of gastrointestinal complications in ICUD was significantly lower than that in ECUD (OR: 0.61; 95% CI: [0.47, 0.80]). The heterogeneity testing suggested good homogeneity among the included studies (I2 = 0%, p=.81).

Figure 9.

Figure 9.

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Meta-Analysis for the Comparison of Gastrointestinal Complications Between ICUD and ECUD

Readmission Rate

Five and four studies, respectively, reported the 30-day and 90-day readmission risks for ICUD and ECUD. The meta-analysis based on the random-effects model (Figure 10) indicated no statistically significant difference in the comparison of the 30-day (RR: 0.96; 95% CI: [0.72, 1.27]) and 90-day (RR: 1.15; 95% CI: [0.80, 1.64]) readmission risks between ICUD and ECUD. Good homogeneity among the included studies was observed based on the heterogeneity testing (30-day readmission: I2 = 41%; 90-day readmission: I2 = 42%; overall: I2 = 39%).

Figure 10.

Figure 10.

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Meta-Analysis for the Comparison of Readmission Rate (30-Day and 90-Day) Between ICUD and ECUD

Discussion

This study was designed as a systematic review and meta-analysis based on the latest cohort studies comparing ICUD and ECUD after robot-assisted radical cystectomy for bladder cancer, with the purpose of offering critical evidence-based data for clarifying the effect of both strategies. The present meta-analysis included 15 eligible articles involving 5,370 patients undergoing robot-assisted radical cystectomy for bladder cancer. Consequently, ICUD can significantly reduce intraoperative bleeding volume, lower the risk of blood transfusion, and reduce the average postoperative time of oral intake and exhaust, yet with prolonged surgical duration by about half an hour when compared with ECUD. Further sensitivity analysis suggested that ICUD can decrease the overall risk of 90-day complications postoperatively. However, there was no statistically significant difference concerning the impact of ICUD and ECUD on the length of stay in the hospital and readmission risk.

Results in this study were consistent with those reported previously. For instance, Feng et al. (2020), for the first time, compared and analyzed the perioperative outcomes of ICUD and ECUD after robot-assisted radical cystectomy for bladder cancer. Corresponding meta-analysis of 9 studies revealed that ICUD could reduce intraoperative bleeding volume (MD: −90.5, 95% CI: [−131.26, −49.74]) and gastrointestinal complications (RR: 0.65; 95% CI: [0.45, 0.93]), yet without statistically significant association of ICUD with blood transfusion rate and surgical duration. In addition, similar results were found in an analysis of 13 retrospective studies carried out by Cai et al. (2021).

In our study, ICUD was associated with lower bleeding volume and blood transfusion rate. As for possible reasons, compared with open radical cystectomy, robot-assisted radical cystectomy for bladder cancer has the advantage of reducing the bleeding volume and blood transfusion rate (Satkunasivam et al., 2019; Tzelves et al., 2019), which were also observed in this study. Moreover, pneumoperitoneum pressure can create a better surgical field of view and operating condition, and reduce blood flow and vascular dilation intraperitoneally, thus reducing intraoperative bleeding (Kostakopoulos et al., 2022). According to previous studies (Harraz et al., 2024; Zhang et al., 2020), blood transfusion may increase the risk of tumor recurrence and death after radical cystectomy, and reducing blood transfusion may be beneficial for tumor patients. Besides, the good surgical field of view and operating condition can facilitate lesion removal, and alleviate the extent of surgical trauma and tissue damage, thereby accelerating intestinal function recovery and shortening the postoperative time of exhaust (Shim et al., 2020).

Furthermore, ICUD also has a positive effect on decreasing the incidence of postoperative complications, with the risk of gastrointestinal complications reduced to 0.61 (95% CI: [0.47, 0.80]). In a prospective study carried out by Bochner et al. (2015), the most common complications in radical cystectomy for bladder cancer were intestinal complications and infection; undoubtedly, complications related to intestinal incision were one of the biggest issues in Urology, and also an important reason for prolonging the length of stay in the hospital. Ahmed et al. (2014) also demonstrated that prolonged exposure of the peritoneum extracorporeally might increase the risk of intestinal inflammation, which would lead to intestinal complications such as intestinal paralysis or obstruction. In addition, shortening the extracorporeal exposure time of abdominal organs can reduce the intraoperative stress response to benefit patients’ recovery (Knox et al., 2013).

Nevertheless, this study still has the following limitations. First, this meta-analysis was conducted based on observational studies, all of which were cohort studies, without the inclusion of randomized controlled studies, leading to the potential weakening of the causal inference power of this study. Second, studies included in this meta-analysis did not elaborate on the impact of surgeon experience on the results, which may be an important reason for the heterogeneity among the included studies. As a result, this study failed to further evaluate the effect of surgeons’ learning curve on the therapeutic outcome. Besides, the quality of life and other longer-term prognostic outcomes were not compared among studies included in this analysis.

Conclusion

In conclusion, ICUD after robot-assisted radical cystectomy for bladder cancer is safe and feasible, especially in reducing the risk of blood transfusion and gastrointestinal complications, and shortening the postoperative time of exhaust and oral intake. It can be popularized clinically for muscle-invasive bladder cancer or high-risk non-muscle-invasive bladder cancer patients with surgical indications. Considering the existing limitations in this study, further analysis based on multiple prospective studies conducted by experienced surgeons is still required to validate the results of the current study.

Footnotes

Author Contributions: SA conceived of the study. LS, YL, and LR participated in its design and data analysis and statistics. KZ and MZ helped to draft the manuscript. All authors read and approved the final manuscript.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethics Approval and Consent to Participate: An ethics statement is not applicable because this study is based exclusively on published literature.

Availability of Data and Materials: All data generated or analyzed during this study are included in this published article.

References

  1. Ahmed K., Khan S. A., Hayn M. H., Agarwal P. K., Badani K. K., Balbay M. D., Castle E. P., Dasgupta P., Ghavamian R., Guru K. A., Hemal A. K., Hollenbeck B. K., Kibel A. S., Menon M., Mottrie A., Nepple K., Pattaras J. G., Peabody J. O., Poulakis V., . . .Khan M. S. (2014). Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium. European Urology, 65(2), 340–347. [DOI] [PubMed] [Google Scholar]
  2. Bertolo R., Agudelo J., Garisto J., Armanyous S., Fergany A., Kaouk J. (2019). Perioperative outcomes and complications after robotic radical cystectomy with intracorporeal or extracorporeal ileal conduit urinary diversion: Head-to-head comparison from a single-institutional prospective study. Urology, 129, 98–105. [DOI] [PubMed] [Google Scholar]
  3. Bochner B. H., Dalbagni G., Sjoberg D. D., Silberstein J., Keren Paz G. E., Donat S. M., Coleman J. A., Mathew S., Vickers A., Schnorr G. C., Feuerstein M. A., Rapkin B., Parra R. O., Herr H. W., Laudone V. P. (2015). Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: A randomized clinical trial. European Urology, 67(6), 1042–1050. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cai Z., Li H., Hu J., Qiu D., Yi Z., Chen J., Zu X. (2021). Intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy: A pooled analysis. Gland Surgery, 10(2), 706–720. 10.21037/gs-20-740 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dalimov Z., Iqbal U., Jing Z., Wiklund P., Kaouk J., Kim E., Wijburg C., Wagner A. A., Roupret M., Dasgupta P., Gaboardi F., Richstone L., Aboumohamed A., Hussein A. A., Guru K. A. (2022). Intracorporeal versus extracorporeal neobladder after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium. Urology, 159, 127–132. [DOI] [PubMed] [Google Scholar]
  6. Dell’Oglio P., Mazzone E., Lambert E., Vollemaere J., Goossens M., Larcher A., Van Der Jeugt J., Devos G., Poelaert F., Uvin P., Collins J., De Naeyer G., Schatteman P., D‘Hondt F., Mottrie A. (2021). The effect of surgical experience on perioperative and oncological outcomes after robot-assisted radical cystectomy with intracorporeal urinary diversion: Evidence from a referral centre with extensive experience in robotic surgery. European Urology Focus, 7(2), 352–358. [DOI] [PubMed] [Google Scholar]
  7. DerSimonian R., Laird N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188. [DOI] [PubMed] [Google Scholar]
  8. Feng D., Tang Y., Yang Y., Han P., Wei W. (2020). Intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy: Evidence from a systematic review and pooled analysis of observational studies. Minerva Urologica e Nefrologica, 72(5), 519–530. [DOI] [PubMed] [Google Scholar]
  9. Guru K., Seixas-Mikelus S. A., Hussain A., Blumenfeld A. J., Nyquist J., Chandrasekhar R., Wilding G. E. (2010). Robot-assisted intracorporeal ileal conduit: Marionette technique and initial experience at Roswell Park Cancer Institute. Urology, 76(4), 866–871. [DOI] [PubMed] [Google Scholar]
  10. Harraz A. M., Elkarta A., Zahran M. H., Mosbah A., Shaaban A. A., Abol-Enein H. (2024). The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram. Asian Journal of Urology, 11(2), 294–303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Higgins J., Altman D. G. (2008). Chapter 8: Assessing risk of bias in included studies. In Higgins J., Green S. (Eds.), Cochrane handbook for systematic reviews of interventions (Version 5.0). Cochrane Collaboration. [Google Scholar]
  12. Hu J. C., Chughtai B., O’Malley P., Halpern J. A., Mao J., Scherr D. S., Hershman D. L., Wright J. D., Sedrakyan A. (2016). Perioperative outcomes, health care costs, and survival after robotic-assisted versus open radical cystectomy: A national comparative effectiveness study. European Urology, 70(1), 195–202. [DOI] [PubMed] [Google Scholar]
  13. Hussein A. A., May P. R., Jing Z., Ahmed Y. E., Wijburg C. J., Canda A. E., Dasgupta P., Shamim Khan M., Menon M., Peabody J. O., Hosseini A., Kelly J., Mottrie A., Kaouk J., Hemal A., Wiklund P., Guru K. A. & Collaborators. (2018). Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium. Journal of Urology, 199(5), 1302–1311. [DOI] [PubMed] [Google Scholar]
  14. Kang S. G., Ko Y. H., Jang H. A., Kim J., Kim S. H., Cheon J., Kang S. H. (2012). Initial experience of robot-assisted radical cystectomy with total intracorporeal urinary diversion: Comparison with extracorporeal method. Journal of Laparoendoscopic & Advanced Surgical Techniques, 22(5), 456–462. [DOI] [PubMed] [Google Scholar]
  15. Kingo P. S., Nørregaard R., Borre M., Jensen J. B. (2017). Postoperative C-reactive protein concentration and clinical outcome: Comparison of open cystectomy to robot-assisted laparoscopic cystectomy with extracorporeal or intracorporeal urinary diversion in a prospective study. Scand Journal of Urology, 51(5), 381–387. [DOI] [PubMed] [Google Scholar]
  16. Knox M. L., El-Galley R., Busby J. E. (2013). Robotic versus open radical cystectomy: Identification of patients who benefit from the robotic approach. Journal of Endourology, 27(1), 40–44. [DOI] [PubMed] [Google Scholar]
  17. Kostakopoulos N., Athanasiadis G., Omar M. I., Abraham J., Dimitropoulos K. (2022). The impact of low-pressure pneumoperitoneum on robotic-assisted radical cystectomy and intracorporeal ileal conduit urinary diversion: A case-control study. World Journal of Urology, 40(10), 2467–2472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lenfant L., Verhoest G., Campi R., Parra J., Graffeille V., Masson-Lecomte A., Vordos D., de La Taille A., Roumiguie M., Lesourd M., Taksin L., Misraï V., Grande P., Vaessen C., Ploussard G., Granger B., Rouprêt M. (2018). Perioperative outcomes and complications of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy for bladder cancer: A real-life, multi-institutional French study. World Journal of Urology, 36(11), 1711–1718. [DOI] [PubMed] [Google Scholar]
  19. Mistretta F. A., Musi G., Collà Ruvolo C., Conti A., Luzzago S., Catellani M., Di Trapani E., Cozzi G., Bianchi R., Ferro M., Cioffi A., Cordima G., Brescia A., Verweij F., Bottero D., Matei D. V., Mirone V., De Cobelli O. (2021). Robot-assisted radical cystectomy for nonmetastatic urothelial carcinoma of urinary bladder: A comparison between intracorporeal versus extracorporeal orthotopic ileal neobladder. Journal of Endourology, 35(2), 151–158. [DOI] [PubMed] [Google Scholar]
  20. Morizane S., Nakane K., Tanaka T., Zennami K., Muraoka K., Ebara S., Miura N., Uemura K., Sobu R., Hoshi A., Taoka R., Sugimoto M., Noma H., Sunada H., Nishiyama H., Habuchi T., Ikeda I., Saika T., Makiyama K., . . .Takenaka A. (2024). Comparison of perioperative outcomes and complications between intracorporeal, extracorporeal, and hybrid ileal conduit urinary diversion during robot-assisted radical cystectomy: A comparative propensity score-matched analysis from nationwide multi-institutional study in Japan. International Journal of Clinical Oncology, 29(1), 64–71. [DOI] [PubMed] [Google Scholar]
  21. Page M. J., McKenzie J. E., Bossuyt P. M., Boutron I., Hoffmann T. C., Mulrow C. D., Shamseer L., Tetzlaff J. M., Akl E. A., Brennan S. E., Chou R., Glanville J., Grimshaw J. M., Hróbjartsson A., Lalu M. M., Li T., Loder E. W., Mayo-Wilson E., McDonald S., . . .Moher D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372(71). [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Pruthi R. S., Nix J., McRackan D., Hickerson A., Nielsen M. E., Raynor M., Wallen E. M. (2010). Robotic-assisted laparoscopic intracorporeal urinary diversion. European Urology, 57(6), 1013–1021. [DOI] [PubMed] [Google Scholar]
  23. Pyun J. H., Kim H. K., Cho S., Kang S. G., Cheon J., Lee J. G., Kim J. J., Kang S. H. (2016). Robot-assisted radical cystectomy with total intracorporeal urinary diversion: Comparative analysis with extracorporeal urinary diversion. Journal of Laparoendoscopic & Advanced Surgical Techniques, 26(5), 349–355. [DOI] [PubMed] [Google Scholar]
  24. Satkunasivam R., Tallman C. T., Taylor J. M., Miles B. J., Klaassen Z., Wallis C. J. D. (2019). Robot-assisted radical cystectomy versus open radical cystectomy: A meta-analysis of oncologic, perioperative, and complication-related outcomes. European Urology Oncology, 2(4), 443–447. [DOI] [PubMed] [Google Scholar]
  25. Shim J. S., Kwon T. G., Rha K. H., Lee Y. G., Lee J. Y., Jeong B. C., Pyun J. H., Kang S. G., Kang S. H. (2020). Do patients benefit from total intracorporeal robotic radical cystectomy? A comparative analysis with extracorporeal robotic radical cystectomy from a Korean multicenter study. Investigative and Clinical Urology, 61(1), 11–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stang A. (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology, 25(9), 603–605. [DOI] [PubMed] [Google Scholar]
  27. Su S., Gu L., Ma X., Li H., Wang B., Shi T., Zhang X. (2019). Comparison of laparoscopic and robot-assisted radical cystectomy for bladder cancer: Perioperative and oncologic outcomes. Clinical Genitourinary Cancer, 17(5), e1048–e1053. [DOI] [PubMed] [Google Scholar]
  28. Taber C., Lee B., Djang R., Shone E., Perry J., Patel S. G. (2024). Evaluating the differences of wound related complications in robotically assisted radical cystectomy vs open radical cystectomy. Urology. Advance online publication. 10.1016/j.urology.2024.05.026 [DOI] [PMC free article] [PubMed]
  29. Tan T. W., Nair R., Saad S., Thurairaja R., Khan M. S. (2019). Safe transition from extracorporeal to intracorporeal urinary diversion following robot-assisted cystectomy: A recipe for reducing operative time, blood loss and complication rates. World Journal of Urology, 37(2), 367–372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Teoh J. Y., Chan E. O., Kang S. H., Patel M. I., Muto S., Yang C. K., Hatakeyama S., Chow T. S., Mok A., Zhang R., Kijvikai K., Lee L. S., Chen H., Ohyama C., Horie S., Chan E. S. (2021). Perioperative outcomes of robot-assisted radical cystectomy with intracorporeal versus extracorporeal urinary diversion. Annals of Surgical Oncology, 28(13), 9209–9215. [DOI] [PubMed] [Google Scholar]
  31. Tong S., Yang Z., Zu X., Li Y., He W., Li Y., Hu X., Zhao C., Chen M., Qi L. (2019). Anterior versus posterior approach laparoscopic radical cystectomy: A retrospective analysis. World Journal of Surgical Oncology, 17(1), 9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tzelves L., Skolarikos A., Mourmouris P., Lazarou L., Kostakopoulos N., Manatakis D. K., Kural A. R. (2019). Does the use of a robot decrease the complication rate adherent to radical cystectomy? A systematic review and meta-analysis of studies comparing open with robotic counterparts. Journal of Endourology, 33(12), 971–984. [DOI] [PubMed] [Google Scholar]
  33. Wéber A., Vignat J., Shah R., Morgan E., Laversanne M., Nagy P., Kenessey I., Znaor A. (2024). Global burden of bladder cancer mortality in 2020 and 2040 according to GLOBOCAN estimates. World Journal of Urology, 42(1), 237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Wilson T. G., Guru K., Rosen R. C., Wiklund P., Annerstedt M., Bochner B. H., Chan K. G., Montorsi F., Mottrie A., Murphy D., Novara G., Peabody J. O., Palou Redorta J., Skinner E. C., Thalmann G., Stenzl A., Yuh B., Catto J. & Pasadena Consensus Panel. (2015). Best practices in robot-assisted radical cystectomy and urinary reconstruction: Recommendations of the Pasadena Consensus Panel. European Urology, 67(3), 363–375. [DOI] [PubMed] [Google Scholar]
  35. Xu C., Furuya-Kanamori L., Zorzela L., Lin L., Vohra S. (2021). A proposed framework to guide evidence synthesis practice for meta-analysis with zero-events studies. Journal of Clinical Epidemiology, 135, 70–78. [DOI] [PubMed] [Google Scholar]
  36. Zhang J. H., Ericson K. J., Thomas L. J., Knorr J., Khanna A., Crane A., Mittal R., Zampini A., Fascelli M., Murthy P. B., Haber G. P., Lee B. (2020). Large single institution comparison of perioperative outcomes and complications of open radical cystectomy, intracorporeal robot-assisted radical cystectomy and robotic extracorporeal approach. Journal of Urology, 203(3), 512–521. [DOI] [PubMed] [Google Scholar]

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