The Association between Urinary Diversion Type and Other-Cause Mortality in Radical Cystectomy Patients

Simple Summary This study, conducted within a large North American cohort from the Surveillance, Epidemiology and End Results (SEER) database (2004-2020), aimed to investigate whether more complex urinary diversion (UD) procedures, such as orthotopic neobladder and abdominal pouch, are associated with higher other-cause mortality (OCM) compared to the conventional ileal conduit in T1-T4aN0M0 bladder cancer patients. Among 3008 patients, 79% underwent ileal conduit, while 21% opted for continent UD. After rigorous analysis, including propensity score matching and multivariable adjustments, the study found that neither continent UD nor its subtypes (orthotopic neobladder and abdominal pouch) were associated with higher 10-year OCM rates relative to ileal conduit. The conclusion suggests that more intricate UD procedures do not seem to elevate OCM risk compared to the simpler ileal conduit.Abstract Background: It is unknown whether more complex UD, such as orthotopic neobladder and abdominal pouch, may be associated with higher OCM rates than ileal conduit. We addressed this knowledge gap within the SEER database 2004-2020. Methods: All T1-T4aN0M0 radical cystectomy (RC) patients were identified. After 1:1 propensity score matching (PSM), cumulative incidence plots, univariable and multivariable competing-risks regression (CRR) models were used to test differences in OCM rates according to UD type (orthotopic neobladder vs. abdominal pouch vs. ileal conduit). Results: Of all 3008 RC patients, 2380 (79%) underwent ileal conduit vs. 628 (21%) who underwent continent UD (268 orthotopic neobladder and 360 abdominal pouch). After PSM relative to ileal conduit, neither continent UD (13 vs. 15%; p = 0.1) nor orthotopic neobladder (13 vs. 16%; p = 0.4) nor abdominal pouch (13 vs. 15%; p = 0.2) were associated with higher 10-year OCM rates. After PSM and after adjustment for cancer-specific mortality (CSM), as well as after multivariable adjustments relative to ileal conduit, neither continent UD (Hazard Ratio [HR]:0.73; p = 0.1), nor orthotopic neobladder (HR:0.84; p = 0.5) nor abdominal pouch (HR:0.77; p = 0.2) were associated with higher OCM. Conclusions: It appears that more complex UD types, such as orthotopic neobladder and abdominal pouch are not associated with higher OCM relative to ileal conduit.