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ORIGINAL RESEARCH article
Front. Oncol.
Sec. Genitourinary Oncology
Volume 14 - 2024 |
doi: 10.3389/fonc.2024.1435050
Intracorporeal urinary diversion offers the advantage of delaying postoperative renal function injury in patients undergoing robot-assisted radical cystectomy
Provisionally accepted
Hao Wang
1,2
Wendi Wang
1,3*
Xun Wang
1,2*
Changhua Fang
1*
Kangkang Zhao
1,2*
Tianyi Chen
1,3*
Chengwei Zhang
1
Shiwei Zhang
1*
Hongqian Guo
1
Gutian Zhang
1*- 1 Nanjing Drum Tower Hospital, Nanjing, China
- 2 School of Medicine, Nanjing University, Nanjing, Liaoning Province, China
- 3 School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
[Abstract] Objective To analyze changes in renal function and associated risk factors in patients with bladder cancer undergoing robot-assisted radical cystectomy (RARC) with intracorporeal or extracorporeal urinary diversion (ICUD or ECUD). Methods Clinical-pathological data was extracted from electronic medical records of 266 patients with bladder cancer who underwent RARC at our institution between August 2015 and August 2022. Postoperative renal function was assessed using the estimated glomerular filtration rate (eGFR). Result Patients were classified into ECUD and ICUD groups based on the surgical approach. Significant differences in eGFR were observed between the two groups at 1, 2, and 3 years postoperatively. Moreover, 112 patients (42.1%) experienced long-term renal function injury. Independent risk factors for long-term renal function injury included the type of surgical approach, ureteroenteric anastomotic strictures, and pathological stage T3 or above. In terms of short-term renal function, 30 cases of acute kidney injury (AKI) were observed, with an incidence rate of 11.3%. No difference in AKI incidence was found between the groups. Conclusions Postoperative AKI and chronic kidney injury are prevalent complications following RC. This study highlights that pathological stage, ureteroenteric anastomotic strictures, and ECUD significantly impact long-term renal function, but the type of urinary diversion (ileal conduit or orthotopic neobladder) had no effect on renal function, and ICUD was superior in terms of long-term renal injury rate. Therefore, precise preoperative assessment and the selection of appropriate surgical approach are crucial for preserving renal function in patients with bladder cancer.
Keywords: Bladder cancer, Robot-assisted radical cystectomy, Urinary Diversion, Acute Kidney Injury, Chronic kidney injury
Received: 19 May 2024; Accepted: 13 Aug 2024.
Copyright: © 2024 Wang, Wang, Wang, Fang, Zhao, Chen, Zhang, Zhang, Guo and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wendi Wang, Nanjing Drum Tower Hospital, Nanjing, China
Xun Wang, Nanjing Drum Tower Hospital, Nanjing, China
Changhua Fang, Nanjing Drum Tower Hospital, Nanjing, China
Kangkang Zhao, Nanjing Drum Tower Hospital, Nanjing, China
Tianyi Chen, Nanjing Drum Tower Hospital, Nanjing, China
Shiwei Zhang, Nanjing Drum Tower Hospital, Nanjing, China
Gutian Zhang, Nanjing Drum Tower Hospital, Nanjing, China
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