Sim Allen, Balbay Mevlana Derya, Todenhöfer Tilman, Aufderklamm Stefan, Halalsheh Omar, Mischinger Johannes, Böttge Johannes, Rausch Steffen, Bier Simone, Stenzl Arnulf, Gakis Georgios, Schwentner Christian, Canda Abdullah Erdem
Department of Urology, Eberhard-Karls University Tuebingen, Germany.
Department of Urology, Memorial Şişli Hospital, Istanbul, Turkey.
Cent European J Urol. 2015;68(1):18-23. doi: 10.5173/ceju.2015.01.466. Epub 2014 Dec 31.
Robot-assisted radical cystectomy (RARC) plus intracorporeal urinary diversion is feasible. Few centers worldwide demonstrated comparable functional and oncologic outcomes. We reported a large series of RARC and intracorporeal diversion to assess its feasibility and reproducibility.
We identified 101 RARCs in 82 men and 19 women (mean age 68.3 years) from October 2009 to October 2014. The patients underwent RARC and pelvic lymphadenectomy followed by intracorporeal urinary diversion (ileal conduit/ neobladder). Out of the 101 patients, 28 (27.7%) received intracorporeal ileal conduits and 73 (72.3%) intracorporeal neobladders. Studer pouch was performed in all the patients who underwent intracorporeal neobladder formation. Perioperative, functional and oncologic results including CSS and OS are reported.
Mean operative time was 402.3 minutes (205-690) and blood loss was 345.3 ml (50-1000). The mean hospital stay was 17.1 days (5-62). All the surgeries were completed with no open conversion. Minor complications (Grade I and II) were reported in 27.7% of patients while major complications (grade III and above) were reported in 36.6% of patients. The mean nodal yield was 20.6 (0-46). Positive ureteric margins were found in 8.9% of patients. The average follow-up was 27.5 months (1-52). Daytime continence could be achieved in 89.2% of patients who underwent intracorporeal neobladder. The 3-year cancer specific survival (CSS) and overall survival (OS) was 80.2% and 69.8% respectively.
RARC with intracorporeal diversion is safe and reproducible in 'non-pioneer' tertiary centers with robotic expertise having acceptable operative time and complications as well as comparable functional and oncologic outcomes.
机器人辅助根治性膀胱切除术（RARC）加体内尿流改道术是可行的。全球很少有中心能取得类似的功能和肿瘤学结果。我们报告了一系列大量的RARC和体内尿流改道术病例，以评估其可行性和可重复性。
我们确定了2009年10月至2014年10月期间101例接受RARC手术的患者，其中男性82例，女性19例（平均年龄68.3岁）。患者接受了RARC和盆腔淋巴结清扫术，随后进行体内尿流改道术（回肠膀胱术/新膀胱术）。在这101例患者中，28例（27.7%）接受了体内回肠膀胱术，73例（72.3%）接受了体内新膀胱术。所有接受体内新膀胱术的患者均采用Studer术式。报告了围手术期、功能和肿瘤学结果，包括癌症特异性生存（CSS）和总生存（OS）情况。
平均手术时间为402.3分钟（205 - 690分钟），失血量为345.3毫升（50 - 1000毫升）。平均住院时间为17.1天（5 - 62天）。所有手术均顺利完成，无中转开放手术情况。27.7%的患者报告有轻微并发症（I级和II级），36.6%的患者报告有严重并发症（III级及以上）。平均淋巴结收获数为20.6个（0 - 46个）。8.9%的患者发现输尿管切缘阳性。平均随访时间为27.5个月（1 - 52个月）。接受体内新膀胱术的患者中，89.2%可实现日间控尿。3年癌症特异性生存率（CSS）和总生存率（OS）分别为80.2%和69.8%。
在具备机器人技术专长的“非先驱”三级中心，RARC联合体内尿流改道术安全且可重复，手术时间和并发症可接受，功能和肿瘤学结果相当。
