A systematic review and meta-analysis of intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy in elderly patients with malignancy.

Abstract

Recent studies have highlighted the progress of robotic-assisted radical cystectomy (RARC), yet information on intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD), especially in elderly patients, remains limited. This review seeks to address this gap in the literature. A systematic literature review was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases, following the PRISMA guidelines. Studies comparing ICUD to ECUD in patients aged ≥ 65 years. We combined the data using weighted mean differences (WMD) or odds ratios (OR) with random-effects models. For results showing moderate-to-high heterogeneity, a sensitivity analysis was performed by sequentially excluding individual studies. Nine studies comprising 4340 patients (1967 in ICUD and 2373 in ECUD) were included in the meta-analysis. ICUD was associated with significantly lower estimated blood loss (WMD: - 64.34 mL, 95% CI: - 113.26, - 15.42, P = 0.01), reduced blood transfusion rates (OR: 0.29, 95% CI: 0.11, 0.76, P = 0.01), and fewer overall gastrointestinal complications (OR: 0.65, 95% CI: 0.46, 0.92, P = 0.016) compared to ECUD in patients aged 65 and older. No significant differences were found in operative duration, length of hospitalization, or 30-day/90-day complication and readmission rates. Sensitivity analysis indicated low evidence for outcomes such as blood loss and transfusion rates. Overall, elderly patients undergoing RARC may benefit from ICUD in terms of reduced blood loss, lower blood transfusion rates, and fewer gastrointestinal complications. However, large prospective randomized studies are still required to confirm these findings.