Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer.
Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer.
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DOI：
10.1016/j.urolonc.2011.06.009
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发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Kibel AS
中科院分区：
文献类型：
--
作者：
Nepple KG;Strope SA;Grubb RL 3rd;Kibel AS
机器人化疗的肿瘤学结局集中在病理学上，而不是生存终点。我们比较了自引入机器人膀胱术以来，开放式和机器人膀胱术的单个外科医生系列的病理学、复发和生存率。我们确定了2007年6月至2010年6月期间由一名外科医生进行根治性膀胱癌治疗的所有患者。从病历审查中提取临床、人口统计学和病理学数据。死亡率来自机构癌症登记和图表审查。由于机器人手术的相对禁忌症，患者被排除在分析之外。对接受机器人（n=36）与开放式（n=29）膀胱术的其余患者队列进行了评价，中位随访时间为12.2个月。机器人队列更可能是老年人和男性（p<0.05）。肥胖、合并症、术前病理和接受新辅助化疗在两组之间没有差异。3例患者因难以分离而从机器人手术转为开放手术。机器人手术的平均手术时间更长（410 vs. 345分钟，p<0.01）。机器人手术与开放手术在分期、切缘状态或平均淋巴结计数方面没有差异（机器人：17.0，开放：15.5）。在解释随访时间差异的生存分析中（图1），机器人和开放式手术的无复发、疾病特异性和总生存率结果相似（所有对数秩p值>0.05）。Kaplan-Meier估计2年无复发、疾病特异性和总生存率为67%（95% CI：41-83），75%（95% CI：53-88），68%（95% CI：47-82），机器人Cybergram和58%（95% CI：29-79），63%（95% CI：34-82），63%（95% CI：34-82）开放式手术的短期肿瘤学结局与机器人手术相似。在声称长期生存率相等之前，需要增加样本量和进一步随访。
Oncologic outcomes of robotic cystectomy have focused on pathology and not on survival endpoints. We compared pathology, recurrence, and survival in a single surgeon series of open and robotic cystectomy since the introduction of robotic cystectomy. We identified all patients treated by a single surgeon with radical cystectomy for urothelial cancer from June 2007 – June 2010. Clinical, demographic, and pathologic data was abstracted from chart review. Mortality was obtained from institutional cancer registry and chart review. Patients were excluded from analysis for a relative contraindication to robotic surgery. The remaining cohort of patients undergoing robotic (n=36) versus open (n=29) cystectomy with median follow-up 12.2 months were evaluated. The robotic cohort was more likely to be older and male (p<0.05). Obesity, comorbidity, preoperative pathology, and receipt of neoadjuvant chemotherapy were not different between groups. Three patients had conversion from robotic to open cystectomy because of difficult dissection. Mean surgical time was longer in robotic cystectomy (410 vs. 345 minutes, p<0.01). Cystectomy pathology was not different for robotic versus open surgery for stage, margin status, or mean node count (robotic: 17.0, open: 15.5). On survival analysis which accounts for differences in follow-up time (Figure 1), robotic and open cystectomy outcomes were similar with respect to recurrence-free, disease-specific, and overall survival (all log-rank p values >0.05). The Kaplan-Meier estimate for 2-year outcome for recurrence-free, disease-specific, and overall survival was 67% (95% CI: 41-83), 75% (95% CI: 53-88), 68% (95% CI: 47-82) for robotic cystectomy and 58% (95% CI: 29-79), 63% (95% CI: 34-82), 63% (95% CI: 34-82) for open cystectomy Short-term oncologic outcomes were similar for open and robotic cystectomy. Increased sample size and further follow-up are necessary before claiming equivalent long-term survival.
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