PD33-07\u2003DOES INCORPORATION OF ROBOT-ASSISTED INTRA-CORPOREAL NEOBLADDER IMPACT HEALTH-RELATED QUALITY OF LIFE OUTCOMES? A MATCHED ANALYSIS

Abstract

INTRODUCTION AND OBJECTIVES: Intra-corporeal orthotopic neobladder substitution has been incorporated in clinical practice with changes intechnique to assist with robot-assisted approach. There is lack of sufficient evidence for the equality of patient related results with this novel over the traditional open approach. We aimed to perform a matched comparison between different types of diversion after robot-assisted radical cystectomy (RARC). METHODS: Retrospective review of patients who underwent RARC in our institution was performed. Patients were divided into 3 groups: intracorporeal neobladder (ICNB), extracorporeal neobladder (ECNB), intracorporeal ileal conduit (ICIC). Propensity score match for patient and disease characteristics was performed. QoL was assessed using the Bladder Cancer Index (BCI) and European Organization for Research and Treatment of Cancer Body Image scale (BIS) questionnaires were utilized to evaluate health-related QoL at 3 time points after RARC: early (3-6 m), intermediate (6-12 m) and late (>12 m). ICNB was compared to ECNB, then another comparison between ICNB and ICIC was performed. Logistic regression model was utilized to evaluate predictors of better QoL for all domains at each time point. RESULTS: 11 patients in each of the ICNB and ECNB groups and 22 patients ICIC were identified. There was no significant difference in perioperative and pathologic outcomes between all groups. Compared to ECNB, ICNB was not inferior in urinary, bowel, sexual function and body image domains at all time points (Figure 1A). On the other hand, urinary function scores in ICIC was significantly better than ICNB (94 vs 54, p=0.006) early after surgery, but this difference decreased with time (92 vs 73, p=0.06 at 6-12 months) and (90 vs 73, p=0.20 at >12 months) (Figure 1B). Early after RARC, type of diversion (ileal conduit, mean +30 points) was associated with better urinary function scores. On intermediate follow up, males demonstrated higher urinary function scores. The effect of these 2 variables diminished after 1 year of follow up. CONCLUSIONS: Incorporation of ICNB (initial experience and technique evolution) were not associated with changes in QoL after RARC. The difference between ICNB and ICIC diminished at 1 year. Figure. No caption available. Source of Funding: Roswell Park Alliance Foundation