Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Urol. 2010 Feb;183(2):510-4. doi: 10.1016/j.juro.2009.10.027. Epub 2009 Dec 14.
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.
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.
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.
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.
根治性膀胱切除术仍然是治疗局限性浸润性膀胱癌和复发性非浸润性疾病的最有效方法。最近，一些外科医生开始描述对这种疾病采用侵袭性较小的手术方法的结果，例如腹腔镜或机器人辅助技术。我们报告了我们在 100 例连续接受机器人辅助腹腔镜根治性膀胱切除术的患者中的成熟经验，涉及围手术期结果、病理结果和手术并发症。
2006 年 1 月至 2009 年 1 月，我院对 100 例临床局限性膀胱癌患者连续行机器人辅助根治性膀胱切除术和尿流改道术。评估的结果测量包括手术变量、住院恢复情况、病理结果和并发症发生率。
该队列的平均年龄为 65.5 岁（范围 33 至 86 岁）。其中 61 例行回肠导管转流术，38 例行新膀胱术，1 例未行尿流改道术（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 毫升（中位数 250）。手术病理上，40%的病例为 pT1 或更低疾病，27%为 pT2，13%为 pT3/T4 疾病，20%为淋巴结阳性。平均切除淋巴结数为 19 个（范围 8 至 40 个）。无一例手术切缘阳性。排气平均时间为 2.1 天，排便为 2.8 天，出院为 4.9 天。36 例患者中有 41 例术后并发症，8%为严重并发症（Clavien 3 级或更高），11%在术后 30 天内再次入院。平均随访 21 个月后，15 例患者疾病复发，6 例患者死于疾病。
我们报告了一项相对较大且成熟的机器人根治性膀胱切除术治疗膀胱癌的经验，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。
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