Haber Georges-Pascal, Crouzet Sebastien, Gill Inderbir S
Department of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, United States.
Eur Urol. 2008 Jul;54(1):54-62. doi: 10.1016/j.eururo.2008.03.076. Epub 2008 Apr 1.
Interest in laparoscopic assisted radical cystectomy (LRC) and robotic assisted radical cystectomy (RRC) is increasing at select centers worldwide. In this update we present the recent worldwide experience and critically evaluate the role of minimally invasive radical surgery for patients with bladder cancer.
English-language literature between 1992 and 2007 was reviewed using the National Library of Medicine database and the following key words: laparoscopic, laparoscopic-assisted, robotic, robotic-assisted, and radical cystectomy. Over 102 papers were identified, 48 of which were selected for this review on the basis of their contribution to advancing the field with regard to three criteria: (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes. These were evaluated with respect to current techniques and perioperative, functional, and oncological outcomes. Our initial experience is also reported.
Minimally invasive techniques can adequately achieve the extirpative aspects of LRC and extended template lymphadenectomy. At most institutions the reconstructive urinary diversion is now typically being performed extracorporeally through a minilaparotomy. Perioperative data indicate that minimally invasive techniques are associated with reduced blood loss, slightly increased operating time, and shorter hospital stay without any significant difference in postoperative complications compared with open surgery. Intermediate-term oncological outcomes appear to be comparable with the open approach. Worldwide experience continues to increase; >700 surgeries have already been performed.
LRC or RRC with extracorporeally constructed urinary diversion is a safe and effective operation for appropriate patients with bladder cancer. Perioperative and functional outcomes are comparable with open surgery. More focus on extended lymphadenectomy is necessary to routinely achieve higher node yields. Surrogate and intermediate oncological outcomes are encouraging, and long-term assessment is ongoing.
全球范围内，部分中心对腹腔镜辅助根治性膀胱切除术（LRC）和机器人辅助根治性膀胱切除术（RRC）的兴趣与日俱增。在本次更新中，我们呈现了近期全球范围内的经验，并对微创根治性手术在膀胱癌患者中的作用进行了批判性评估。
使用美国国立医学图书馆数据库检索了1992年至2007年间的英文文献，检索关键词如下：腹腔镜、腹腔镜辅助、机器人、机器人辅助、根治性膀胱切除术。共识别出102篇以上的论文，其中48篇基于对该领域的推进作用，依据以下三条标准被选入本综述：（1）概念的演变；（2）技术的发展与完善；（3）中期和长期临床结果。对这些论文在当前技术、围手术期、功能及肿瘤学结果方面进行了评估。我们也报告了自己的初步经验。
微创技术能够充分实现LRC的切除目标以及扩大范围的模板式淋巴结清扫。在大多数机构中，现在通常通过小型剖腹手术在体外进行重建性尿流改道。围手术期数据表明，与开放手术相比，微创技术可减少术中失血，手术时间略有延长，住院时间缩短，术后并发症无显著差异。中期肿瘤学结果似乎与开放手术相当。全球范围内的经验持续增加；已完成超过700例手术。
对于合适的膀胱癌患者，采用体外构建尿流改道的LRC或RRC是一种安全有效的手术方式。围手术期和功能结果与开放手术相当。有必要更加关注扩大淋巴结清扫，以便常规获得更高数量的淋巴结。替代指标和中期肿瘤学结果令人鼓舞，长期评估正在进行中。
