ORIGINAL RESEARCH article
Front. Oncol.
Sec. Genitourinary Oncology
This article is part of the Research TopicAdvancements in Robotic Surgery for Urologic Cancer TreatmentView all 5 articles
Effect of early detubularization on urethro-intestinal anastomosis during robot-assisted radical cystectomy and intracorporeal neobladder among bladder cancer patients
Provisionally accepted
- 1Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- 2Department of Urology, Seoul National University College of Medicine, Jongno-gu, Republic of Korea
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Urethro-intestinal anastomosis (UIA) leak is a critical complication of robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (ICN). Although early detubularization of ileal loop has been proposed to facilitate tension-free anastomosis, clinical evidence of its benefits in preventing UIA leaks is limited. We assessed its impact on UIA leak rates in bladder cancer patients undergoing RARC with ICN. We retrospectively identified 580 patients who underwent radical cystectomy at Seoul National University Bundang Hospital between 2003-2025, of which 147 met inclusion criteria for RARC with ICN and were analyzed. Patients were grouped by detubularization timing: before (early) or after (conventional) UIA. Baseline and perioperative features were compared. Univariable analysis and multinomial logistic regression identified potential predictors of UIA leaks and evaluated the independent effect of early detubularization. Among 147 eligible patients, 93 underwent early and 54 underwent conventional detubularization. UIA leaks occurred in 6.1% (9/147), lower in the early group (2.2% vs. 13.0%, P = 0.031). Early detubularization (P = 0.031), length of hospital stay (P = 0.001), and prior abdominal surgery (P = 0.165) were potential predictors using a liberal selection threshold (P < 0.20). Multinomial regression identified early detubularization as an independent protective factor (OR, 0.154; 95% CI, 0.030– 0.784; P = 0.024). Model goodness-of-fit was significant (χ² = 9.775, df = 4, P = 0.044; Nagelkerke R² = 0.096). Early detubularization appears to reduce UIA leaks following RARC with ICN. Our findings support its adoption as a technical refinement to improve anastomotic outcomes, though further prospective validation is needed.
Keywords: Bladder cancer, Radical cystectomy, Robotic Surgical Procedures, Postoperative Complications, Anastomotic Leak
Received: 06 Aug 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Ho Park, Lee, Lee, Hong, Byun and Oh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jong Jin Oh, urojin@snu.ac.kr
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