A Comparison of Postoperative Complications in Open versus Robotic Cystectomy
A Comparison of Postoperative Complications in Open versus Robotic Cystectomy
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DOI：
10.1016/j.eururo.2009.06.001
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发表时间：
2010-02-01
期刊：
影响因子：
23.4
通讯作者：
Scherr, Douglas S.
中科院分区：
文献类型：
--
作者：
Casey, K. Ng;Kauffman, Eric C.;Scherr, Douglas S.
背景：机器人膀胱切除术是治疗浸润性膀胱癌（BCa）的一种新兴替代方法。然而，相对于开放式手术，术后发病率的降低尚未得到证实。目的：比较接受机器人与开放式根治性膀胱切除术 (RC) 的患者的并发症发生率。设计、设置和参与者：对在我们机构接受 RC 的 187 名连续患者进行的前瞻性队列研究 - 104 名开放式 RC，83 名机器人 RC。干预：开放式或机器人 RC 联合尿流改道。测量：前瞻性记录人口统计学、围手术期和并发症数据。使用改良的 Clavien 并发症量表评估 30 天和 90 天的并发症发生率。使用chi(2)和多变量逻辑回归分析评估数据。 结果和局限性：30天时，开放组表现出较高的总体并发症发生率（59% vs 41%；p = 0.04）以及更多主要并发症（30% vs 10%；p = 0.007）。 90 天时，开放组的总体并发症发生率较高，但这并不具有统计学意义（62% vs 48%；p = 0.07）。然而，开放队列的主要并发症发生率明显较高（31% vs 17%；p = 0.03）。当进行逻辑回归分析时，机器人膀胱切除术是 30 和 90 天时总体和主要并发症较少的独立预测因子。美国麻醉医师协会 (ASA) 高评分 (3-4) 和较长的手术时间是主要并发症的独立预测因素。尽管这是最大的已发布 RC 系列之一，但样本量相对较小。此外，尽管两个患者队列相似匹配，但该研究并不是以随机方式进行。结论：接受机器人膀胱切除术的患者比接受开放性膀胱切除术的患者术后并发症更少。机器人膀胱切除术是总体和主要并发症较少的独立预测因素。在获得长期肿瘤学结果之前，机器人膀胱切除术仍应被视为研究性的。 (c) 2009 年欧洲泌尿外科协会。由 Elsevier B.V 出版。保留所有权利。
Background: Robotic cystectomy is an emerging alternative for treatment of invasive bladder cancer (BCa). However, reduction in postoperative morbidity relative to the open approach has not been demonstrated.Objective: To compare complication rates in patients undergoing robotic versus open radical cystectomy (RC).Design, setting, and participants: A prospective cohort study of 187 consecutive patients undergoing RC at our institution- 104 open RC, 83 robotic RC.Intervention: Open or robotic RC with urinary diversion.Measurements: Demographic, perioperative, and complication data were recorded prospectively. Thirty-day and 90-d complication rates were assessed using the modified Clavien complication scale. Data were evaluated using chi(2) and multivariate logistic regression analyses.Results and limitations: At 30 d, the open group demonstrated a higher overall complication rate (59% vs 41%; p = 0.04) as well as more major complications (30% vs 10%; p = 0.007). At 90 d, the overall complication rate was greater in the open group, but this was not statistically significant (62% vs 48%; p = 0.07). However, there was a significantly higher major complication rate in the open cohort (31% vs 17%; p = 0.03). When subjected to logistic regression analysis, robotic cystectomy was an independent predictor of fewer overall and major complications at 30 and 90 d. High American Society of Anesthesiologists (ASA) score (3-4) and longer surgical time were independent predictors of major complications. Though this is one of the largest published RC series, the sample size is relatively small. Moreover, despite the two patient cohorts being similarly matched, the study was not performed in a randomized fashion.Conclusions: Patients undergoing robotic cystectomy experienced fewer postoperative complications than those undergoing open cystectomy. Robotic cystectomy is an independent predictor of fewer overall and major complications. Until long-term oncologic results are available, robotic cystectomy should still be considered investigational. (c) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.