Robotic Radical Cystectomy for Bladder Cancer: Surgical and Pathological Outcomes in 100 Consecutive Cases
Robotic Radical Cystectomy for Bladder Cancer: Surgical and Pathological Outcomes in 100 Consecutive Cases
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DOI：
10.1016/j.juro.2009.10.027
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发表时间：
2010-02-01
影响因子：
6.6
通讯作者：
Wallen, Eric M.
中科院分区：
文献类型：
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作者：
Pruthi, Raj S.;Nielsen, Matthew E.;Wallen, Eric M.
目的：根治性膀胱切除术仍然是局部浸润性膀胱癌和复发性非浸润性疾病患者最有效的治疗方法。最近，一些外科医生已经开始描述与这种疾病的微创手术方法相关的结果，例如腹腔镜或机器人辅助技术。我们报告了100例机器人辅助腹腔镜根治性膀胱癌的围手术期结果、病理结果和手术并发症方面的成熟经验。材料和方法：共100名连续患者（73名男性和27名女性）从2006年1月到2009年1月，在我们的机构接受了机器人根治性膀胱切除术和尿流改道术治疗临床局限性膀胱癌。评估的结局指标包括手术变量、住院康复、病理结局和并发症发生率。结果：该队列的平均年龄为65.5岁（范围33至86岁）。其中61例患者接受了回肠导管分流术，38例接受了新膀胱术，1例未接受尿流改道（肾衰竭）。所有患者的平均手术室时间为4.6小时（中位数4.3），平均手术失血量为271 ml（中位数250）。在手术病理上，40%的病例为pT 1或更低的疾病，27%为pT 2，13%为pT 3/T4疾病，20%为淋巴结阳性。平均切除淋巴结数量为19（范围8 - 40）。在任何情况下都没有一个积极的手术切缘。平均排气天数为2.1天，排便天数为2.8天，出院回家天数为4.9天。36例患者中有41例术后并发症，其中8%有严重并发症（Clavien 3级或以上），11%在手术后30天内再次入院。在平均随访21个月，15例患者的疾病复发，6死于disease.Conclusions：我们报告了一个相对较大的和成熟的经验，机器人根治性膀胱癌的治疗提供了可接受的手术和病理结果。这些结果支持继续努力完善高危膀胱癌的手术治疗。
Purpose: Radical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. Recently some surgeons have begun to describe outcomes associated with less invasive surgical approaches to this disease such as laparoscopic or robotic assisted techniques. We report our maturing experience with 100 consecutive cases of robotic assisted laparoscopic radical cystectomy with regard to perioperative results, pathological outcomes and surgical complications.Materials and Methods: A total of 100 consecutive patients (73 male and 27 female) underwent robotic radical cystectomy and urinary diversion at our institution from January 2006 to January 2009 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes and complication rate.Results: Mean age of this cohort was 65.5 years (range 33 to 86). Of the patients 61 underwent ileal conduit diversion, 38 received a neobladder and 1 had no urinary diversion (renal failure). Mean operating room time for all patients was 4.6 hours (median 4.3) and mean surgical blood loss was 271 ml (median 250). On surgical pathology 40% of the cases were pT1 or less disease, 27% were pT2, 13% were pT3/T4 disease and 20% were node positive. Mean number of lymph nodes removed was 19 (range 8 to 40). In no case was there a positive surgical margin. Mean days to flatus were 2.1, bowel movement 2.8 and discharge home 4.9. There were 41 postoperative complications in 36 patients with 8% having a major complication (Clavien grade 3 or higher) and 11% being readmitted within 30 days of surgery. At a mean followup of 21 months 15 patients had disease recurrence and 6 died of disease.Conclusions: We report a relatively large and maturing experience with robotic radical cystectomy for the treatment of bladder cancer providing acceptable surgical and pathological outcomes. These results support continued efforts to refine the surgical management of high risk bladder cancer.