Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

Satoshi Katayama, Keiichiro Mori, Benjamin Pradere, Hadi Mostafaei, Victor M. Schuettfort, Fahad Quhal, Reza Sari Motlagh, Ekaterina Laukhtina, Marco Moschini, Nico C. Grossmann, Yasutomo Nasu, Shahrokh F. Shariat, Harun Fajkovic

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)


This systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and extracorporeal (ECUD) urinary diversion following robot-assisted radical cystectomy (RARC). A systematic literature search of articles was performed in PubMed®, Web of Science®, and Scopus® databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We included studies that compared patients who underwent RARC with ICUD to those with ECUD. Twelve studies including 3067 patients met the eligibility criteria. There were no significant differences between ICUD and ECUD in overall and major complications, regardless of the period (short-term [≤ 30 days] or mid-term [> 30 days]). Subgroup analyses demonstrated that ICUD performed by high-volume centers exhibited a significantly reduced risk of major complications (short-term: OR 0.57, 95% CI 0.37–0.86, p = 0.008, mid-term: OR 0.66, 95% CI 0.46–0.94, p = 0.02). Patients who underwent ICUD had lower estimated blood loss (MD -102.3 ml, 95% CI − 132.8 to − 71.8, p < 0.00001), less likely to receive blood transfusion rates (OR 0.36, 95% CI 0.20–0.62, p = 0.00003); and these findings were consistent in subgroup analyses by low-volume centers (MD-121.6 ml, 95% CI − 160.9 to − 82.3, p < 0.00001 and OR 0.36, 95% CI 0.20–0.62, p = 0.00003, respectively). ICUD had a higher lymph node yield (MD 3.68, 95% CI 0.80–6.56, p = 0.01). Patients receiving ICUD provided comparable complications, superior perioperative outcomes, and similar oncological outcomes compared with ECUD. Centralization of patients may contribute to a reduction of postoperative complications, while maintaining the advantages.

Original languageEnglish
Pages (from-to)1587-1599
Number of pages13
JournalInternational Journal of Clinical Oncology
Issue number9
Publication statusPublished - Sept 2021


  • Complication
  • Extracorporeal urinary diversion
  • Hospital volume
  • Intracorporeal urinary diversion
  • Meta-analysis
  • Robot-assisted radical cystectomy

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology


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