Is patient outcome compromised during the initial experience with robot-assisted radical cystectomy? Results of 164 consecutive cases
Is patient outcome compromised during the initial experience with robot-assisted radical cystectomy? Results of 164 consecutive cases
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DOI：
10.1111/j.1464-410x.2010.09904.x
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发表时间：
2011-09-01
影响因子：
4.5
通讯作者：
Guru, Khurshid A.
中科院分区：
文献类型：
--
作者：
Hayn, Matthew H.;Hellenthal, Nicholas J.;Guru, Khurshid A.
机器人辅助根治性膀胱切除术（RARC）在肿瘤学结局方面仍然存在争议，特别是在最初的经验中。本研究的目的是评估机器人化疗程序的初始经验对肿瘤学结果和总生存率的影响。患者和方法利用前瞻性维护的单一机构机器人化疗数据库，我们确定了自2005年11月以来接受RARC的164例连续患者。和连续病例数;我们使用卡方分析将连续病例数与手术时间、手术失血量、淋巴结产量和手术切缘状态相关联。我们还讨论了并发症和连续病例数之间的关系。然后，我们利用考克斯比例风险模型和Kaplan-Meier生存分析将变量与总死亡率进行相关性分析，结果表明，连续病例数与并发症、手术失血量或手术切缘阳性的发生率增加无显著相关性（P = 0.780，P = 0.548，P = 0.545）。然而，病例数与较短的手术时间和平均淋巴结取出数显著相关序贯病例数与生存率无显著相关性（P> 0.05）;然而，肿瘤分期、淋巴结转移的存在和手术切缘阳性与死亡显著相关。虽然是同类中最大的，这是一项小型研究，与开放性cycloplasticseries. CONCLUSION相比，RARC的初始经验并不影响单一机构系列中的阳性手术切缘、手术/术后并发症或总生存率的发生率。
OBJECTIVERobot-assisted radical cystectomy (RARC) remains controversial in terms of oncologic outcomes, especially during the initial experience. The purpose of this study was to evaluate the impact of initial experience of robotic cystectomy programs on oncologic outcomes and overall survival.PATIENTS AND METHODSUtilizing a prospectively maintained, single institution robotic cystectomy database, we identified 164 consecutive patients who underwent RARC since November 2005.After stratification by age group, gender, pathologic T stage, lymph node status, surgical margin status, and sequential case number; we used chi-squared analyses to correlate sequential case number to operative time, surgical blood loss, lymph node yield, and surgical margin status.We also addressed the relationship between complications and sequential case number. We then utilized Cox proportional hazard modeling and Kaplan-Meier survival analyses to correlate variables to overall mortality.RESULTSSequential case number was not significantly associated with increased incidence of complications, surgical blood loss, or positive surgical margins (P = 0.780, P = 0.548, P = 0.545). Case number was, however, significantly associated with shorter operative time and mean number of lymph nodes retrieved (P < 0.001, P < 0.001).Sequential case number was not significantly associated with survival; however, tumour stage, the presence of lymph node metastases, and positive surgical margins were significantly associated with death.Although being the largest of its kind, this was a small study with short follow-up when compared to open cystectomy series.CONCLUSIONInitial experience with RARC did not affect the incidence of positive surgical margins, operative/postoperative complications, or overall survival in a single-institution series.