Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.
Eur Urol. 2011 Nov;60(5):1066-73. doi: 10.1016/j.eururo.2011.07.035. Epub 2011 Aug 4.
Robot-assisted radical cystectomy (RARC) may reduce morbidity after cystectomy. Descriptions of the surgical techniques of RARC with intracorporeal orthotopic neobladder or ileal conduit are sparse and oncologic and functional outcome data have not been reported.
We present our technique with RARC and intracorporeal urinary diversion (neobladder or ileal conduit) and present oncologic and functional outcomes, as well as complication rates.
DESIGN, SETTING, AND PARTICIPANTS: Single-hospital institution case-series from 2004 to 2009 including 45 selected patients (38 male, 7 female) with high-grade and/or muscle-invasive urothelial cancer of the bladder.
We performed RARC; pelvic lymph node dissection using three different templates; and a totally intracorporeal urinary diversion, either orthotopic neobladder (n=36) or ileal conduit (n=9).
Perioperative variables, pathology data, early and late complication rates, urinary continence, potency, and cancer-specific survival were evaluated as outcome measures.
Median patient age, operative time, estimated blood loss, and lymph node yield were 62 yr (range: 37-79), 477 min (range: 325-760), 550 ml (range: 200-2200), and 19 (range: 10-52), respectively. Nine patients were diagnosed with positive lymph nodes. Surgical margins were clear in all but one patient. Early complications occurred in 18 patients (40%). Median postoperative stay was 9 d (range: 4-78), and median postoperative follow-up time was 25 mo. Four patients died due to metastatic disease. The study is limited by a relative small sample size and no comparative group.
RARC with totally intracorporeal urinary diversion is technically feasible with good intermediate-term oncologic results. This is a nonrandomised study including a limited number of patients with a restricted follow-up time, however, and so precautions must be considered when interpreting the outcomes.
机器人辅助根治性膀胱切除术（RARC）可能会降低膀胱切除术后的发病率。关于 RARC 联合腔内原位新膀胱或回肠导管的手术技术描述较少，且尚未报道其肿瘤学和功能结果以及并发症发生率。
我们介绍了采用 RARC 联合腔内尿路改道术（新膀胱或回肠导管）的技术，并报告了肿瘤学和功能结果以及并发症发生率。
设计、地点和参与者：2004 年至 2009 年，单家医院的病例系列研究，包括 45 名（38 名男性，7 名女性）高级别和/或肌肉浸润性膀胱癌患者。
我们进行了 RARC；使用三种不同模板进行盆腔淋巴结清扫；并进行了完全腔内尿路改道，包括原位新膀胱（n=36）或回肠导管（n=9）。
评估围手术期变量、病理数据、早期和晚期并发症发生率、尿控、性功能和癌症特异性生存率作为结局指标。
中位患者年龄、手术时间、估计失血量和淋巴结检出数分别为 62 岁（范围：37-79）、477 分钟（范围：325-760）、550 毫升（范围：200-2200）和 19（范围：10-52）。9 名患者诊断为淋巴结阳性。除 1 名患者外，所有患者的手术切缘均为阴性。18 名患者发生早期并发症（40%）。中位术后住院时间为 9 天（范围：4-78），中位术后随访时间为 25 个月。4 名患者死于转移性疾病。该研究的局限性在于样本量相对较小且无对照组。
RARC 联合完全腔内尿路改道术在技术上是可行的，且具有良好的中期肿瘤学结果。这是一项非随机研究，包括数量有限的患者和有限的随访时间，因此在解释结果时必须谨慎。
