Abstract
Objective
To evaluate differences in the incidence of benign ureteroenteric stricture, we compared
stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy
(ORC) using Surveillance, Epidemiology, and End Results-Medicare data.
Methods
We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture
rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture
as the need for procedural intervention. Additionally, we compared the incidence of
stricture diagnosis. Multivariable proportional hazards regression was performed to
determine factors associated with stricture development.
Results
The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs
ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly
at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following
ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis
(HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher
hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63).
Conclusion
RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention
on a population-based level that is mitigated by higher hospital volume. A significant
study limitation is inability to differentiate extracorporeal vs intracorporeal diversion.
However, a stricture complication compounds the financial burden of care and efforts
must be pursued to improve this surgical outcome.
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Article info
Publication history
Published online: October 13, 2019
Accepted:
July 18,
2019
Received:
January 6,
2019
Footnotes
Funding: Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
