Guiote I, Gaya J M, Gausa L, Rodríguez O, Palou J
Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, España.
Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, España.
Actas Urol Esp. 2016 Mar;40(2):108-14. doi: 10.1016/j.acuro.2015.03.002. Epub 2015 Apr 24.
Radical cystectomy with extended lymphadenectomy is the surgical treatment of choice for muscle-invasive bladder cancer. The technical and technological improvements and the positive results from robot-assisted kidney and prostate surgery have led to the progressive development of robot-assisted radical cystectomy (RARC). We provide a global structured overview and an update on the complications of RARC, recorded according to the Clavien-Dindo classification system.
We conducted a search on PubMed of all publications on RARC to date (2014). Of the 259 publications found, we excluded review articles and cost analyses, publications with less than 30 cases, updates of previous studies and those whose main objective was the study of other issues related to RARC other than complications, leaving a total of 38 articles for the final analysis.
The most common complications associated with RARC are gastrointestinal, infectious and genitourinary system, mainly Clavien 1-2, followed by Clavien 3-4. RARC had lower overall complication rates than open radical cystectomy and laparoscopic radical cystectomy and had a lower incidence of severe complications, less intraoperative bleeding and better postoperative recovery.
Although further scientific evidence is needed, RARC is an increasingly widespread technique that appears to reduce complications as well as the need for transfusion, and it improves recovery times.
根治性膀胱切除术联合扩大淋巴结清扫术是肌层浸润性膀胱癌的手术治疗选择。技术和工艺的改进以及机器人辅助肾脏和前列腺手术取得的积极成果，推动了机器人辅助根治性膀胱切除术（RARC）的逐步发展。我们根据Clavien-Dindo分类系统，对RARC的并发症进行了全面的结构化概述和更新。
我们在PubMed上检索了截至2014年所有关于RARC的出版物。在找到的259篇出版物中，我们排除了综述文章和成本分析、病例数少于30例的出版物、先前研究的更新以及那些主要目的是研究与RARC并发症无关的其他问题的文章，最终留下38篇文章进行分析。
与RARC相关的最常见并发症是胃肠道、感染和泌尿生殖系统并发症，主要为Clavien 1-2级，其次是Clavien 3-4级。RARC的总体并发症发生率低于开放性根治性膀胱切除术和腹腔镜根治性膀胱切除术，严重并发症发生率较低，术中出血较少，术后恢复较好。
尽管需要更多科学证据，但RARC是一种应用越来越广泛的技术，似乎能减少并发症以及输血需求，并缩短恢复时间。
