Department of Urologic Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
Eur Urol. 2010 Aug;58(2):197-202. doi: 10.1016/j.eururo.2010.04.024. Epub 2010 Apr 23.
Robot-assisted radical cystectomy (RARC) has evolved as a minimally invasive alternative to open radical cystectomy for patients with invasive bladder cancer.
We sought to define the learning curve for RARC by evaluating results from a multicenter, contemporary, consecutive series of patients who underwent this procedure.
DESIGN, SETTING, AND PARTICIPANTS: Utilizing the International Robotic Cystectomy Consortium database, a prospectively maintained and institutional review board-approved database, we identified 496 patients who underwent RARC by 21 surgeons at 14 institutions from 2003 to 2009.
Cut-off points for operative time, lymph node yield (LNY), estimated blood loss (EBL), and margin positivity were identified. Using specifically designed statistical mixed models, we were able to inversely predict the number of patients required for an institution to reach the predetermined cut-off points.
Mean operative time was 386 min, mean EBL was 408 ml, and mean LNY was 18. Overall, 34 of 482 patients (7%) had a positive surgical margin (PSM). Using statistical models, it was estimated that 21 patients were required for operative time to reach 6.5h and 8, 20, and 30 patients were required to reach an LNY of 12, 16, and 20, respectively. For all patients, PSM rates of <5% were achieved after 30 patients. For patients with pathologic stage higher than T2, PSM rates of <15% were achieved after 24 patients.
RARC is a challenging procedure but is a technique that is reproducible throughout multiple centers. This report helps to define the learning curve for RARC and demonstrates an acceptable level of proficiency by the 30th case for proxy measures of RARC quality.
机器人辅助根治性膀胱切除术（RARC）已成为浸润性膀胱癌患者的一种微创替代开放根治性膀胱切除术。
通过评估一组接受该手术的多中心、连续、同期患者的结果，我们旨在确定 RARC 的学习曲线。
设计、地点和参与者：利用国际机器人膀胱癌切除术协会数据库，这是一个前瞻性维护和机构审查委员会批准的数据库，我们从 2003 年至 2009 年确定了 14 个机构的 21 名外科医生对 496 例患者进行了 RARC。
确定手术时间、淋巴结产量（LNY）、估计失血量（EBL）和切缘阳性的截止点。使用专门设计的统计混合模型，我们能够反向预测机构达到预定截止点所需的患者数量。
平均手术时间为 386 分钟，平均 EBL 为 408ml，平均 LNY 为 18。总体而言，482 例患者中有 34 例（7%）有阳性手术切缘（PSM）。使用统计模型，估计需要 21 例患者才能达到 6.5 小时的手术时间，需要 8、20 和 30 例患者才能达到 12、16 和 20 的 LNY。对于所有患者，在 30 例患者后达到<5%的 PSM 率。对于病理分期高于 T2 的患者，在 24 例患者后达到<15%的 PSM 率。
RARC 是一项具有挑战性的手术，但它是一种可在多个中心重复的技术。本报告有助于确定 RARC 的学习曲线，并通过第 30 例患者证明了 RARC 质量的代理测量的可接受水平的熟练程度。
