Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy
Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy
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DOI：
10.1111/j.1464-410x.2007.07212.x
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发表时间：
2008-01-01
影响因子：
4.5
通讯作者：
Scherr, Douglas S.
中科院分区：
文献类型：
--
作者：
Wang, Gerald J.;Barocas, Daniel A.;Scherr, Douglas S.
为了前瞻性地比较连续一系列接受根治性膀胱切除术(RC)和开放或机器人尿流改道手术的患者的围手术期和病理结果。从2006年2月到2007年4月，54名患者接受了由一名外科医生进行的RC手术。21个是开放的，33个使用达芬奇机器人系统(直觉外科，加利福尼亚州桑尼维尔，美国)。前瞻性收集数据，包括患者人口统计学、手术和术后变量以及病理结果。机器人队列减少了失血量(400vs750ml，P=0.002)和输血量(2.0vs0.5U，P=0.007)，但延长了手术时间(390vs300min，P=0.03)。机器人组恢复正常饮食的时间(4天比5天，P=0.002)和住院时间(5天比8天，P=0.007)都有所减少。总体来说，并发症发生率相似(开放手术24%，机器人手术21%，P=0.3)。开放队列中膀胱外病变(57vs28%，P=0.03)和淋巴结转移(34vs19%，P=0.04)患者较多。切开组有3例，机器人组有2例切缘阳性(P=0.2)。开放组和机器人组的中位淋巴结清除量相似(20对17，P=0.6)。与开放组相比，机器人辅助RC似乎提供了一些手术和围手术期的好处，而不影响早期肿瘤学疗效的病理指标，如淋巴结产量和切缘状况。需要有长期随访的更大规模的随机研究来证实这些发现，并建立肿瘤学上的等效性。
To prospectively compare perioperative and pathological outcomes in a consecutive series of patients undergoing radical cystectomy (RC) and urinary diversion by the open or the robotic approach.From February 2006 to April 2007, 54 consecutive patients underwent RC by one surgeon at our institution. Twenty-one were open, while 33 utilized the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). Data was collected prospectively, including patient demographics, operative and postoperative variables, and pathological outcomes.The robotic cohort had decreased blood loss (400 vs 750 mL, P = 0.002) and transfusion requirement (2.0 vs 0.5 units, P = 0.007), but increased operative duration (390 vs 300 min, P = 0.03). The time to resumption of a regular diet (4 vs 5 days, P = 0.002) and the hospital stay (5 vs 8 days, P = 0.007) were decreased in the robotic group. Overall the complication rates were similar (24% open, 21% robotic, P = 0.3). The open cohort had more patients with extravesical disease (57 vs 28%, P = 0.03) and nodal metastasis (34 vs 19%, P = 0.04). There were three patients in the open group and two in the robotic with positive margins (P = 0.2). The median number of lymph nodes removed was similar in the open and robotic cohorts (20 vs 17, P = 0.6).Robotic-assisted RC appears to offer some operative and perioperative benefits compared with the open approach without compromising pathological measures of early oncological efficacy, such as lymph node yield and margin status. Larger, randomized studies with long-term follow-up are required to confirm these findings and establish oncological equivalence.