Academic Journal
Intraoperative pelvic drain placement and postoperative outcomes following robot-assisted radical cystectomy: a contemporary NSQIP analysis.
| Τίτλος: | Intraoperative pelvic drain placement and postoperative outcomes following robot-assisted radical cystectomy: a contemporary NSQIP analysis. |
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| Συγγραφείς: | Abdessater M; Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon. ma718@aub.edu.lb., Touma Sawaya R; Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon., Balaghi A; Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon. |
| Πηγή: | Journal of robotic surgery [J Robot Surg] 2026 Jul 24; Vol. 20 (1). Date of Electronic Publication: 2026 Jul 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Country of Publication: England NLM ID: 101300401 Publication Model: Electronic Cited Medium: Internet ISSN: 1863-2491 (Electronic) Linking ISSN: 18632483 NLM ISO Abbreviation: J Robot Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : Springer |
| Ιατρικοί όροι (MeSH): | Cystectomy*/methods , Cystectomy*/adverse effects , Robotic Surgical Procedures*/methods , Robotic Surgical Procedures*/adverse effects , Drainage*/methods , Drainage*/adverse effects , Postoperative Complications*/epidemiology , Postoperative Complications*/prevention & control , Postoperative Complications*/etiology , Intraoperative Care*/methods, Pelvis/surgery ; Urinary Tract Infections/epidemiology ; Urinary Tract Infections/etiology ; Humans ; Female ; Male ; Middle Aged ; Aged ; Treatment Outcome ; Operative Time ; Length of Stay |
| Περίληψη: | Pelvic drains have traditionally been utilized following radical cystectomy to facilitate early identification of urinary leaks and postoperative complications. However, evidence supporting routine drain placement following robot-assisted radical cystectomy (RARC) remains limited. This study evaluated the association between intraoperative pelvic drain placement and postoperative outcomes following RARC. Patients undergoing RARC were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified according to intraoperative pelvic drain placement. Baseline characteristics, perioperative variables, and 30-day postoperative outcomes were compared between cohorts. Multivariable logistic and linear regression analyses adjusting for demographic characteristics, comorbidities, American Society of Anesthesiologists classification, and operative time were performed. A total of 5,256 patients undergoing RARC were identified, including 4,946 (94.1%) managed with pelvic drains and 310 (5.9%) without drains. Drain placement was associated with longer operative duration (363.3 ± 124.8 vs. 294.6 ± 117.6 min, p < 0.001), while no significant difference hospital length of stay was found between cohorts (p = 0.294). On unadjusted analysis, urinary tract infection was more common in patients managed without drains (9.4% vs. 5.2%, p = 0.002), whereas ureteral obstruction was more frequent in the drain cohort (5.6% vs. 2.3%, p = 0.012). Rates of mortality, readmission, reoperation, overall complications, urinary leak, sepsis, and surgical site infection were otherwise similar between groups. Following multivariable adjustment, drain placement was independently associated with lower odds of urinary tract infection (adjusted odds ratio [aOR] 0.55, 95% confidence interval [CI] 0.37-0.84, p = 0.005) and higher odds of ureteral obstruction (aOR 2.85, 95% CI 1.31-6.19, p = 0.009), without significant associations with most other major postoperative outcomes. Routine pelvic drain placement following RARC was not independently associated with reductions in most major postoperative complications. These findings suggest that routine prophylactic drain utilization may provide limited overall benefit following contemporary robotic cystectomy and support a more individualized approach to drain placement. (© 2026. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.) |
| Competing Interests: | Declarations. Competing interests: The authors declare no competing interests. Consent to publish: Not applicable. Human ethics and consent to participate: Not applicable. Clinical trial number: Not applicable. |
| References: | Alfred Witjes J, Max Bruins H, Carrión A et al (2024) European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol 85(1):17–31. https://doi.org/10.1016/j.eururo.2023.08.016. (PMID: 10.1016/j.eururo.2023.08.01637858453) Hirobe M, Tanaka T, Shindo T et al (2018) Complications within 90 days after radical cystectomy for bladder cancer: results of a multicenter prospective study in Japan. Int J Clin Oncol 23(4):734–741. https://doi.org/10.1007/s10147-018-1245-z. (PMID: 10.1007/s10147-018-1245-z29442282) Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55(1):164–174. https://doi.org/10.1016/j.eururo.2008.07.031. (PMID: 10.1016/j.eururo.2008.07.03118675501) Mastroianni R, Tuderti G, Ferriero M et al (2024) Robot-assisted Radical Cystectomy with Totally Intracorporeal Urinary Diversion Versus Open Radical Cystectomy: 3-Year Outcomes from a Randomised Controlled Trial. Eur Urol 85(5):422–430. https://doi.org/10.1016/j.eururo.2024.01.018. (PMID: 10.1016/j.eururo.2024.01.01838336579) Simhal RK, Simon DP, Wang KR et al (2024) Perioperative and Complication Related Outcomes for Robotic-Assisted vs Open Radical Cystectomy: A Comparative National Surgical Quality Improvement Project Analysis. J Endourol 38(4):331–339. https://doi.org/10.1089/end.2023.0279. (PMID: 10.1089/end.2023.027938269428) Lee M, Eun DD (2026) Robotic Radical Cystectomy of the Bladder. In: StatPearls. StatPearls Publishing; Accessed May 26, 2026. http://www.ncbi.nlm.nih.gov/books/NBK604466/. Yan B, Liu Y, Li Y et al (2025) Intracorporeal versus extracorporeal urinary diversion during robotic radical cystectomy: outcomes from a large single-institutional study. BMC Urol 25(1):179. https://doi.org/10.1186/s12894-025-01872-x. (PMID: 10.1186/s12894-025-01872-x4069155112278537) Lee G, Patel HV, Srivastava A, Ghodoussipour S (2022) Updates on enhanced recovery after surgery for radical cystectomy. Ther Adv Urol 14:17562872221109022. https://doi.org/10.1177/17562872221109022. (PMID: 10.1177/17562872221109022358448319280843) Wessels F, Lenhart M, Kowalewski KF et al (2020) Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols. World J Urol 38(12):3139–3153. https://doi.org/10.1007/s00345-020-03133-y. (PMID: 10.1007/s00345-020-03133-y321240207716903) Faba OR, Moreno RP, Malca L et al (2018) Postoperative management of radical cystectomy. Review of the evidence on the prevention and treatment of urological complications. Actas Urológicas Españolas (English Edition) 42(3):143–151. https://doi.org/10.1016/j.acuroe.2018.02.002. (PMID: 10.1016/j.acuroe.2018.02.002) Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1084. https://doi.org/10.1097/01.sla.0000146149.17411.c5 . discussion 1084–1085. (PMID: 10.1097/01.sla.0000146149.17411.c5155702121356522) Karliczek A, Jesus EC, Matos D, Castro AA, Atallah AN, Wiggers T (2006) Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis 8(4):259–265. https://doi.org/10.1111/j.1463-1318.2006.00999.x. (PMID: 10.1111/j.1463-1318.2006.00999.x16630227) Pellegrino F, Leni R, Basile G et al (2024) Peri- and post-operative outcomes of robot-assisted radical cystectomy after the implementation of the EAU guidelines recommendations for collecting and reporting complications at a high-volume referral center. World J Urol 42(1):270. https://doi.org/10.1007/s00345-024-04970-x. (PMID: 10.1007/s00345-024-04970-x38679650) Territo A, Baboudjian M, Diana P et al (2023) To drain or not to drain in uro-oncological robotic surgery? A systematic review and meta-analysis. Minerva Urol Nephrol 75(2):144–153. https://doi.org/10.23736/S2724-6051.22.05160-6. (PMID: 10.23736/S2724-6051.22.05160-636722161) Pfail J, Drobner J, Kaldany A et al (2024) Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients. World J Urol 42(1):601. https://doi.org/10.1007/s00345-024-05320-7. (PMID: 10.1007/s00345-024-05320-73947085011522192) Taylor Z, Musallam S, Meyer K et al (2024) Tubeless ureteroenteric anastomosis in robot-assisted radical cystectomy with intracorporeal urinary diversion does not increase the risk of anastomotic stenosis or postoperative complications. J Robot Surg 18(1):361. https://doi.org/10.1007/s11701-024-02116-0. (PMID: 10.1007/s11701-024-02116-039367889) Rich JM, Geduldig J, Cumarasamy S et al (2023) Eliminating the routine use of postoperative drain placement in patients undergoing robotic-assisted radical cystectomy with intracorporeal urinary diversion. Urologic Oncology: Seminars Original Investigations 41(11):457. e1-457.e7. (PMID: 10.1016/j.urolonc.2023.08.015) Katayama S, Mori K, Pradere B et al (2021) Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis. Int J Clin Oncol 26(9):1587–1599. https://doi.org/10.1007/s10147-021-01972-2. (PMID: 10.1007/s10147-021-01972-2341461858364906) Rich JM, Tillu N, Geduldig J et al (2025) Contemporary outcomes for robotic radical cystectomy and intracorporeal neobladder urinary diversion. Urol Oncol 43(6):392e. 13-392.e21. (PMID: 10.1016/j.urolonc.2025.02.006) Ma J, Chang Y, Xu W et al (2023) Pelvic drain placement after robot-assisted radical prostatectomy: meta-analysis. BJS Open 7(6):zrad143. https://doi.org/10.1093/bjsopen/zrad143. (PMID: 10.1093/bjsopen/zrad1433815539510754771) Hautmann RE, de Petriconi RC, Volkmer BG (2011) 25 years of experience with 1,000 neobladders: long-term complications. J Urol 185(6):2207–2212. https://doi.org/10.1016/j.juro.2011.02.006. (PMID: 10.1016/j.juro.2011.02.00621497841) |
| Contributed Indexing: | Keywords: Enhanced recovery after surgery; NSQIP; Pelvic drain; Postoperative complications; Robot-assisted radical cystectomy |
| Entry Date(s): | Date Created: 20260724 Date Completed: 20260724 Latest Revision: 20260724 |
| Update Code: | 20260724 |
| DOI: | 10.1007/s11701-026-03725-7 |
| PMID: | 42496757 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1863-2491 |
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| DOI: | 10.1007/s11701-026-03725-7 |