Analysis of renal function changes and associated risk factors following robot assisted radical cystectomy with intracorporeal or extracorporeal urinary diversion
Wang Hao
Wang Wendi
Fang Changhua
Zhao Kangkang
Chen Tianyi
Zhang Chengwei
Zhang Shiwei
Guo Hongqian
Zhang Gutian
Abstract：Objective:To analyze renal function changes and associated risk factors in bladder cancer patients un-derwent robot assisted radical cystectomy(RARC)with intracorporeal or extracorporeal urinary diversion(UD).Methods:The clinical data of 266 patients with bladder cancer who underwent RARC+UD in Drum Tower Hospi-tal Affiliated to Nanjing University Medical School from May 2016 to August 2021 were retrospectively analyzed.There were 232 males and 34 females,the average age were(67.4±9.4)years,84 cases of orthotopic neobladder(ON)and 182 cases of ileal conduit(IC).Long-term changes in renal function postoperatively were assessed via esti-mated glomerular filtration rate(eGFR).Logistic regression was utilized to identify risk factors for renal function inju-ry.Results:The patients were divided into extracorporeal urinary diversion(ECUD)group and intracorporeal urinary diversion(ICUD)group based on different surgical approaches to bowel handling during urinary diversion.The aver-age operative duration between the two groups had no significant difference(P=0.080),with less average estimated blood loss in the ICUD group[(303.5±116.5)ml]than that in the ECUD group[(379.8±233.2)ml],the difference was statistically significant(P=0.007).The eGFR at 1,2 and 3 years postoperatively in the ECUD group were(92.3±26.5),(90.4±26.5)and(88.1±28.3)ml/(min·1.73 m2),respectively;and in the ICUD group were(98.9±23.3),(97.3±23.3)and(95.7±23.5)ml/(min·1.73 m2),respectively,and there were all statistically sig-nificant differences between the two groups(P=0.042,0.034,0.037).During the follow-up period,a total of 112 pa-tients(42.1%,112/266)experienced long-term renal function injury,with 12 cases(4.5%,12/266)progressing to chronic kidney disease(CKD)3B or above,including 9 cases(11.4% )in the ECUD group and 3 cases(1.6% )in the ICUD group,showing statistically significant difference(P<0.001).Patients were categorized into renal injury group and non-renal injury group based on the presence or absence of long-term renal function injury during the follow-up pe-riod.Univariate analysis comparing clinical data between the two groups revealed statistically significant differences in age(P=0.007),surgical approach(P<0.001),ureteroenteric anastomotic stricture(P<0.001),pathological stage T3 or above(P<0.001),postoperative hydronephrosis(P=0.006),and blood loss(P=0.007).By the multivariate analysis,different surgical approaches(OR=0.24,95% CI:0.12-0.46,P<0.001),ureteroenteric anastomotic stric-ture(OR=4.37,95% CI:1.32-14.45,P=0.016),and pathological stage T3 or above(OR=6.21,95% CI:3.20-12.07,P<0.001)were identified as independent risk factors for long-term renal function injury after surgery.A total of 30 patients(11.3% )developed acute kidney injury(AKI)during the follow-up period,including 6 cases(7.6% )in the ECUD group and 24 cases(12.8% )in the ICUD group,and the difference between the two groups was not statis-tically significant(P=0.217).Conclusion:Postoperative AKI and chronic kidney injury are common complications following radical resection in bladder cancer patients.Tumor characteristics(pathological stage),ureteroenteric anas-tomotic strictures and the choice of surgical approach(ECUD and ICUD)were independent risk factors of long-term renal function injury.Therefore,precise preoperative assessment,selection of appropriate surgical approaches and long-term follow-up are of paramount importance in preserving renal function in bladder cancer patients.
Keywords：bladder cancerrobot assisted radical cystectomyurinary diversionacute kidney injurychronic kidney disease
Publication Date：2024-08-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 265-272 )