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Factors influencing intraoperative conversion from planned orthotopic to non-orthotopic urinary diversion during radical cystectomy.
- Source :
-
World Journal of Urology . Sep2019, Vol. 37 Issue 9, p1851-1855. 5p. - Publication Year :
- 2019
-
Abstract
- Objectives: To determine and investigate the intraoperative factors that contribute to a change in plan from continent orthotopic neobladder to ileal conduit or continent cutaneous diversion at the time of radical cystectomy. Subjects and methods: A retrospective review of our prospectively maintained bladder cancer database was performed. Of the 711 patients who underwent radical cystectomy from 2012 to 2016, 387 (54.4%) had given consent to have a NB. Of these 387 patients, 348 (89.9%) ultimately received a neobladder while 34 (8.8%) received an ileal conduit and 5 (1.3%) continent cutaneous diversion. The factors involved in the intraoperative change of plan were examined in this study. Results: Patients who ultimately received a neobladder were significantly more likely to have clinical node-negative disease (p = 0.045), negative soft tissue margins (p = 0.001), lower body mass index (p = 0.045) and higher volume surgeons (p < 0.001). Oncologic reasons for intraoperative conversions were more common than technical reasons (58.3% vs 35.9%), in both robotic and open surgical techniques. The choice of surgical approach (open vs robotic) did not influence the rate of intraoperative conversion. Conclusion: The factors influencing intraoperative decision not to perform neobladder are predominantly oncologic rather than technical. A clear understanding of the factors involved in influencing the intraoperative change in the urinary diversion plan may improve shared decision making in patients undergoing radical cystectomy in the future. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 07244983
- Volume :
- 37
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- World Journal of Urology
- Publication Type :
- Academic Journal
- Accession number :
- 138396020
- Full Text :
- https://doi.org/10.1007/s00345-018-2582-2