Intracorporeal ileal conduit versus orthotopic neobladder after robotic radical cystectomy: A systematic review and meta-analysis of complications and perioperative outcomes

Introduction: This systematic review and meta-analysis were performed to generate evidence on the complication rates between robot-assisted radical cystectomy and intracorporeal ileal conduit (RARC ICIC) and RARC and intracorporeal orthotopic neobladder (RARC ICONB). Methods: A systematic search of the PubMed, Scopus, and Web of Science databases was performed, and all the articles from inception up to June 30, 2024, were screened. Studies reporting on perioperative complications as per the Clavien-Dindo classification and comparing RARC ICIC with RARC ICONB were included. This systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results: A total of 9 studies evaluating 999 patients were included in the final analysis, and all were retrospective analyses of prospectively maintained databases. The 30-day and 90-day complication rates, including the Clavien-Dindo I-II and III-V and the overall complication rate, were similar between RARC ICIC and RARC ICONB. RARC ICONB had a longer operative time (weighted mean difference - 69.62 min) and higher blood loss (weighted mean difference - 50.53 ml). Patients with stage pT4 and N1 were more in the RARC ICIC group as was the rate of positive surgical margin, which suggests an inherent selection bias while offering the procedure. Conclusion: This systematic review, which included only retrospective small-sized series, found that the 30-day and 90-day complication rates between RARC ICIC and RARC ICONB are similar; however, these results are marred by apparent selection bias while offering the procedure. Thus, larger, better-quality prospective randomized studies are required to provide high-quality evidence.