Comparison of perioperative outcomes between extracorporeal and intracorporeal urethral diversion in robot-assisted radical cystectomy: a meta-analysis and systematic review

This study compared the perioperative outcomes of ECUD and ICUD after robot-assisted radical cystectomy for bladder cancer by systematic review and meta-analysis. Our study was registered in PROSPERO, (CRD420250655207). A search strategy was constructed based on PICO principles and subject term extensions (Mesh Term and Emtree), and 149 publications were retrieved in in Pubmed, Web of Science, Embase and Cochrane Library. The literature was screened by two researchers using Endnote following the PROSPERO process and inclusion–exclusion criteria, and four studies were retained. In total, 975 patients with ECUD and 419 patients with ICUD were included. Baseline levels were assessed using the Fixed Mantel–Haenszel method and Random I-V heterogeneit. The patient’s condition is consistent. The quality of the retained cohort study articles was assessed using the New Castle Ottawa Scale (NOS). All 4 studies were of high quality. Perioperative outcomes included blood loss, time to urethral diversion, overall operative time, length of stay, number of 90 day readmissions, number of early major complications, number of 90 day complications, and number of early complications. Data were transformed using RevMan 5.4 and means and standard deviations were estimated. Data were transformed and statistically analysed using StataMP 16, with continuous variables assessed using standardised mean difference (SMD) and 95% confidence intervals (CI), and categorical variables assessed using odds ratios (OR) and 95%CIs, with heterogeneity and sensitivity analyses. Robot-assisted radical cystectomy for bladder cancer after ECUD resulted in shorter overall operative time and urethral diversion time compared to ICUD, with mean reductions of 93.54 and 36.85 min, respectively. Early complications were more in ECUD compared to ICUD. There was no difference in blood loss, length of hospital stay, 90 day rehospitalisation, early major complications, or early complications.