Early and late post-procedural complications in different orthotopic neobladder surgical approaches: A systematic review

• Published in: Surgical oncology Vol. 55; p. 102090
• Main Authors: Mirto, Benito Fabio, Barone, Biagio, Balsamo, Raffaele, Abate, Marco, Caputo, Vincenzo Francesco, Sciarra, Antonella, Calogero, Armando, Romano, Lorenzo, Napolitano, Luigi, Sciorio, Carmine, Lucarelli, Giuseppe, Lasorsa, Francesco, Ferro, Matteo, Busetto, Gian Maria, Del Giudice, Francesco, Manfredi, Celeste, Tătaru, Sabin, Pradere, Benjamin, Imbimbo, Ciro, Crocetto, Felice
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-08-2024
• Subjects: Bladder cancer; Orthotopic neobladder; Radical cystectomy; Orthotopic neobladder; Bladder cancer; Radical cystectomy
• ISSN: 0960-7404; 1879-3320; 1879-3320
• DOI: 10.1016/j.suronc.2024.102090

Bladder cancer (BCa) represents the second most common malignancy of the genitourinary tract. The major risk factors include age, gender, smoking attitude, and occupational exposure, while the exact etiopathogenesis is still uncertain. Patients diagnosed with a BCa showing invasion of the muscle layer below the submucosa must undergo radical cystectomy (RC) with urinary diversion (UD). Many different surgical approaches to UD have been developed. Packaging an orthotopic neobladder (ON) with a bowel tract represents the gold standard when certain patient selection criteria are satisfied. Using PRISMA guidelines, we performed a systematic review assessing early (within 90 days) and late (beyond 90 days) post-procedural complications of different ON surgical approaches. A comprehensive systematic search was conducted in PubMed, Scopus, and Google Scholar databases to identify papers starting from 2012 using dedicated keywords (“neobladder”, “orthotopic neobladder”, “complications'' and “outcomes”). A total of 27 articles were found to satisfy the inclusion criteria and selected. Although the ON is a safe procedure that guarantees the patient the best quality of life (QoL), it is not free from risks. Many complications could occur during and after the surgical time which imposes the necessity of strict follow-up and careful checks over time, which should be properly discussed with patients before.
•Using PRISMA guidelines, we performed a systematic review assessing peri- and post-procedural complications and long-term outcomes of different surgical approaches of ONs finding that despite early and late complications rates were generally low, caution should be posed to detect and treat infective and urinary leakage complications.•The current body of evidence in the published literature is still insufficient to assess that any form of UD is superior to the other based on health related QoL and complications outcomes.•Further studies with longer follow-ups are needed.