Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Urology. 2014 Feb;83(2):345-9. doi: 10.1016/j.urology.2013.07.079. Epub 2013 Dec 7.
To compare our initial robotic-assisted nephroureterectomy (RAN) experience with a well-established practice of performing laparoscopic nephroureterectomy (LN) to treat upper tract urothelial carcinoma (UTUC).
We reviewed our prospectively maintained minimally invasive surgery database. Patients who underwent RAN from April 2009 to December 2011 were matched by pathologic tumor stage and age (± 10 years) to those who underwent LN.
Twenty-two matched pairs were evaluated. Mean operative time (298 vs 251 minutes) and estimated blood loss (EBL, 380 vs 233 mL) were significantly higher for RAN, with a greater need for transfusion in this group. Complication rates were similar. The RAN group trended toward more frequent lymph node dissection and greater median node count when lymph node dissection was performed (59% vs 27% [P = .07] and 5.5 vs 1.0 [P = .13]). After a median follow-up of 10 months for RAN and 15 months for LN, no significant difference was seen in the rate of bladder (36% vs 37%) or distant (32% vs 23%) recurrence, with similar median time to any recurrence (9 months vs 4 months, P = .32).
RAN was associated with higher operative time and blood loss likely because of more frequent use of node dissection, robot repositioning, and technical inexperience. Lymph node dissection was more frequently performed with RAN, which reflects surgeon practice patterns. When a lymph node dissection was performed, the median node count was greater with RAN. Our initial experience with RAN suggests that this is an acceptable approach for the management of UTUC.
将我们最初的机器人辅助肾输尿管切除术（RAN）经验与行腹腔镜肾输尿管切除术（LN）治疗上尿路尿路上皮癌（UTUC）的成熟经验进行比较。
我们回顾了我们前瞻性维护的微创外科数据库。将 2009 年 4 月至 2011 年 12 月期间行 RAN 的患者按病理肿瘤分期和年龄（±10 岁）与行 LN 的患者进行匹配。
评估了 22 对匹配的患者。RAN 的平均手术时间（298 分钟比 251 分钟）和估计失血量（EBL，380 毫升比 233 毫升）明显更高，且该组输血的需求更大。并发症发生率相似。当行淋巴结清扫术时，RAN 组倾向于更频繁地进行淋巴结清扫术，并且淋巴结计数中位数更高（59%比 27%[P=.07]和 5.5 比 1.0[P=.13]）。RAN 组的中位随访时间为 10 个月，LN 组为 15 个月，膀胱（36%比 37%）或远处（32%比 23%）复发率无显著差异，任何复发的中位时间相似（9 个月比 4 个月，P=.32）。
RAN 与更高的手术时间和出血量相关，这可能是由于更频繁地进行淋巴结清扫术、机器人重新定位和技术经验不足。RAN 更频繁地进行淋巴结清扫术，这反映了外科医生的实践模式。当进行淋巴结清扫术时，RAN 的中位数淋巴结计数更大。我们最初的 RAN 经验表明，这是治疗 UTUC 的一种可接受的方法。
