Perioperative Outcomes, Health Care Costs, and Survival After Robotic-assisted Versus Open Radical Cystectomy: A National Comparative Effectiveness Study
Perioperative Outcomes, Health Care Costs, and Survival After Robotic-assisted Versus Open Radical Cystectomy: A National Comparative Effectiveness Study
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DOI：
10.1016/j.eururo.2016.03.028
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发表时间：
2016-07-01
期刊：
影响因子：
23.4
通讯作者：
Sedrakyan, Art
中科院分区：
文献类型：
--
作者：
Hu, Jim C.;Chughtai, Bilal;Sedrakyan, Art
背景资料：根治性膀胱切除术是肌层浸润性膀胱癌的金标准治疗方法，关于机器人辅助（RARC）与开放式根治性膀胱切除术（ORC）的比较有效性存在争议。目的：比较RARC与ORC的利用率、围手术期、成本和生存结局。设计、设置和参与者：我们确定了接受RARC（n = 439）或ORC治疗的膀胱尿路上皮癌（n = 7308）在2002-2012年期间使用监测、流行病学和最终结果计划-医疗保险相关数据。结果测量和统计分析：我们使用倾向评分匹配来比较围手术期和生存期结果，包括淋巴结产量、围手术期并发症和医疗费用。结果和局限性：RARC的使用率从2002年的0.7%增加到2012年的18.5%（p < 0.001）。女性分别占RARC和ORC的13.9%和18.1%（p = 0.007）。RARC与更大的淋巴结切除率相关，41.5%对34.9%切除≥ 10个淋巴结（相对风险1.1，95%置信区间[CI] 1.01-1.22，p = 0.03），平均住院时间较短，分别为10.1（+/-标准差7.1）d和11.2（+/- 8.6）d（p = 0.004）。虽然住院费用相似，但RARC与家庭医疗保健利用率增加（相对风险1.14，95% CI 1.04-1.26，p = 0.009）以及30 d（p < 0.01）和90 d（p < 0.01）费用增加相关。中位随访时间为44个月（四分位距16-78），总生存期（风险比0.88，95%CI 0.74-1.05）和癌症特异性生存期（风险比0.91，95%CI 0.66-1.26）相似。结论：RARC提供了等同于ORC的围手术期和中期结局。额外的长期和随机研究需要持续的比较有效性评估的RARC与ORC.Patient摘要：我们的人口为基础的美国研究表明，机器人辅助根治性膀胱癌有类似的围手术期和生存结局，虽然在更高的成本。(C)2016年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Radical cystectomy is the gold-standard management for muscle-invasive bladder cancer, and there is debate concerning the comparative effectiveness of robotic-assisted (RARC) versus open radical cystectomy (ORC).Objective: To compare utilization, perioperative, cost, and survival outcomes of RARC versus ORC.Design, setting, and participants: We identified bladder urothelial carcinoma treated with RARC (n = 439) or ORC (n = 7308) during 2002-2012 using the Surveillance, Epidemiology, and End Results Program-Medicare linked data.Intervention: Comparison of RARC versus ORC.Outcome measurements and statistical analysis: We used propensity score matching to compare perioperative and survival outcomes, including lymph node yield, perioperative complications, and healthcare costs.Results and limitations: Utilization of RARC increased from 0.7% of radical cystectomies in 2002 to 18.5% in 2012 (p < 0.001). Women comprised 13.9% versus 18.1% (p = 0.007) of RARC versus ORC, respectively. RARC was associated with greater lymph node yield with 41.5% versus 34.9% having >= 10 lymph nodes removed (relative risk 1.1, 95% confidence interval [CI] 1.01-1.22, p = 0.03) and shorter mean length of hospitalization at 10.1 (+/- standard deviation 7.1) d versus 11.2 (+/- 8.6) d (p = 0.004). While inpatient costs were similar, RARC was associated with increased home healthcare utilization (relative risk 1.14, 95% CI 1.04-1.26, p = 0.009) and higher 30-d (p < 0.01) and 90-d (p < 0.01) costs. With a median follow-up of 44 mo (interquartile range 16-78), overall survival (hazard ratio 0.88, 95% CI 0.74-1.05) and cancer-specific survival (hazard ratio 0.91, 95% CI 0.66-1.26) were similar.Conclusions: RARC provides equivalent perioperative and intermediate term outcomes to ORC. Additional long-term and randomized studies are needed for continued comparative effectiveness assessment of RARC versus ORC.Patient summary: Our population-based US study demonstrates that robotic-assisted radical cystectomy has similar perioperative and survival outcomes albeit at higher costs. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.