Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
J Urol. 2010 Jul;184(1):87-91. doi: 10.1016/j.juro.2010.03.037. Epub 2010 May 15.
Positive surgical margins at radical cystectomy confer a poor prognosis. We evaluated the incidence and predictors of positive surgical margins in patients who underwent robot assisted radical cystectomy for bladder cancer.
Using the International Robotic Cystectomy Consortium database we identified 513 patients who underwent robot assisted radical cystectomy, as done by a total of 22 surgeons at 15 institutions from 2003 to 2009. After stratification by age group, gender, pathological T stage, nodal status, sequential case number and institutional volume logistic regression was used to correlate variables with the likelihood of a positive surgical margin.
Of the 513 patients 35 (6.8%) had a positive surgical margin. Increasing 10-year age group, lymph node positivity and higher pathological T stage were significantly associated with an increased likelihood of a positive margin (p = 0.010, <0.001 and p <0.001, respectively). Gender, sequential case number and institutional volume were not significantly associated with margin positivity. The rate of margin positive disease at cystectomy was 1.5% for pT2 or less, 8.8% for pT3 and 39% for pT4 disease.
Positive surgical margin rates at robot assisted radical cystectomy for advanced bladder cancer were similar to those in open cystectomy series in a large, multi-institutional, prospective cohort. Sequential case number, a surrogate for the learning curve and institutional volume were not significantly associated with positive margins at robot assisted radical cystectomy.
根治性膀胱切除术的阳性切缘预示着不良的预后。我们评估了 513 名膀胱癌患者接受机器人辅助根治性膀胱切除术的阳性切缘发生率和预测因素。
利用国际机器人膀胱切除术协作组数据库，我们确定了 513 名患者接受了机器人辅助根治性膀胱切除术，这些患者由 15 家机构的 22 名外科医生在 2003 年至 2009 年间进行。按年龄组、性别、病理 T 分期、淋巴结状态、连续病例数和机构容量分层后，采用逻辑回归分析变量与阳性切缘可能性的相关性。
513 名患者中，35 名（6.8%）有阳性切缘。10 年年龄组、淋巴结阳性和较高的病理 T 分期与阳性切缘的可能性增加显著相关（p=0.010、<0.001 和 p<0.001）。性别、连续病例数和机构容量与切缘阳性无显著相关性。膀胱切除术后切缘阳性疾病的发生率为 pT2 或更低为 1.5%，pT3 为 8.8%，pT4 为 39%。
在一个大型、多机构、前瞻性队列中，机器人辅助根治性膀胱切除术治疗晚期膀胱癌的阳性切缘率与开放性膀胱切除术系列相似。连续病例数，代表学习曲线和机构容量与机器人辅助根治性膀胱切除术后的阳性切缘无显著相关性。
