Winters Brian R, Bremjit Prashoban J, Gore John L, Lin Daniel W, Ellis William J, Dalkin Bruce L, Porter Michael P, Harper Jonathan D, Wright Jonathan L
1 Department of Urology, University of Washington School of Medicine , Seattle, Washington.
2 School of Medicine, University of Washington , Seattle, Washington.
J Endourol. 2016 Feb;30(2):212-7. doi: 10.1089/end.2015.0457. Epub 2015 Oct 8.
Treatment for muscle-invasive bladder cancer (MIBC) remains highly morbid despite improving surgical techniques. As the median age of diagnosis is 73, many patients are elderly at the time of cystectomy. We compare perioperative surgical outcomes in elderly patients undergoing robotic vs open radical cystectomy (RC).
Patients >75 years at time of RC were identified. Demographic, clinicopathologic, and perioperative variables were examined. Estimated blood loss (EBL) and length of stay (LOS) data were collected with multivariate linear regression analysis performed to assess whether technique was independently associated with outcomes.
Eighty-seven patients >75 years of age underwent cystectomy for MIBC (58 open, 29 robotic). Mean age was 79.6 (±3.2) and 79.2 (±3.5) for open and robotic groups, respectively (p = 0.64). There were no significant differences in baseline comorbidities, clinical or pathologic stage, or use of neoadjuvant chemotherapy. The mean number of lymph nodes removed was similar (p = 0.08). Robotic cystectomy had significantly longer mean OR times (p < 0.001). On multivariate analyses, robotic surgery was associated with -389cc less EBL (95% CI -547 to -230, p < 0.001) and a -1.5-day-shortened LOS (95%CI -2.9 to -0.2, p = 0.02) compared with open surgery. There were no significant differences in surgical complications or 90-day readmission rates between the two groups.
Robotic cystectomy is safe and feasible in an elderly population. We observed longer OR times with robotic surgery, but with decreased EBL, shorter hospital stays, and comparable complication and readmission rates with open RC. Larger prospective studies are required to confirm these findings.
尽管手术技术不断改进，但肌肉浸润性膀胱癌（MIBC）的治疗仍然具有很高的发病率。由于诊断的中位年龄为73岁，许多患者在膀胱切除术时已属老年。我们比较了接受机器人辅助与开放根治性膀胱切除术（RC）的老年患者的围手术期手术结果。
确定在RC时年龄大于75岁的患者。检查人口统计学、临床病理和围手术期变量。收集估计失血量（EBL）和住院时间（LOS）数据，并进行多变量线性回归分析，以评估手术技术是否与结果独立相关。
87例年龄大于75岁的患者因MIBC接受了膀胱切除术（58例开放手术，29例机器人辅助手术）。开放手术组和机器人辅助手术组的平均年龄分别为79.6（±3.2）岁和79.2（±3.5）岁（p = 0.64）。基线合并症、临床或病理分期或新辅助化疗的使用情况无显著差异。切除的淋巴结平均数量相似（p = 0.08）。机器人辅助膀胱切除术的平均手术时间明显更长（p < 0.001）。多变量分析显示，与开放手术相比，机器人辅助手术的EBL减少389cc（95%CI -547至-230，p < 0.001），LOS缩短1.5天（95%CI -2.9至-0.2，p = 0.02）。两组的手术并发症或90天再入院率无显著差异。
机器人辅助膀胱切除术在老年人群中是安全可行的。我们观察到机器人辅助手术的手术时间更长，但EBL减少，住院时间缩短，且与开放RC的并发症和再入院率相当。需要更大规模的前瞻性研究来证实这些发现。
