Tan Wei Shen, Sridhar Ashwin, Ellis Gidon, Lamb Benjamin, Goldstraw Miles, Nathan Senthil, Hines John, Cathcart Paul, Briggs Tim, Kelly John
Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
Department of Urology, University College London Hospital, London, UK.
Urol Oncol. 2016 Jun;34(6):257.e1-9. doi: 10.1016/j.urolonc.2016.02.010. Epub 2016 Mar 8.
To report and compare early oncological outcomes and cancer recurrence sites among patients undergoing open radical cystectomy (ORC) and robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).
A total of 184 patients underwent radical cystectomy for bladder cancer. ORC cases (n = 94) were performed between June 2005 and July 2014 while iRARC cases (n = 90) were performed between June 2011 and July 2014. Primary outcome was recurrence free survival (RFS). Secondary outcomes were sites of local and metastatic recurrence, cancer specific survival (CSS) and overall survival (OS).
Median follow-up for patients without recurrence was 33.8 months (interquartile range [IQR]: 20.5-45.4) for ORC; and 16.1 months (IQR: 11.2-27.0) for iRARC. No significant difference in age, sex, precystectomy T stage, precystectomy grade, or lymph node yield between ORC and iRARC was observed. The ORC cohort included more patients with≥pT2 (64.8% ORC vs. 38.9% iRARC) but fewer pT0 status (8.5% ORC vs.vs. 22.2% iRARC) due to lower preoperative chemotherapy use (22.3% ORC vs. 34.4% iRARC). Positive surgical margin rate was significantly higher in the ORC cohort (19.3% vs. 8.2%; P = 0.042). Kaplan-Meir analysis showed no significant difference in RFS (69.5% ORC vs. 78.8% iRARC), cancer specific survival (80.9% ORC vs. 84.4% iRARC), or OS (73.5% ORC vs.vs. iRARC 83.8%) at 24 months. Cox regression analysis showed RFS, cancer specific survival and OS were not influenced by cystectomy technique. No significant difference between local and metastatic RFS between ORC and iRARC was observed.
This study has found no difference in recurrence patterns or oncological outcomes between ORC and iRARC. Recurrent metastatic sites vary, but are not related to surgical technique.
报告并比较接受开放性根治性膀胱切除术（ORC）和机器人辅助根治性膀胱切除术并进行体内尿流改道（iRARC）的患者的早期肿瘤学结局和癌症复发部位。
共有184例患者接受了膀胱癌根治性膀胱切除术。ORC组（n = 94）于2005年6月至2014年7月进行手术，而iRARC组（n = 90）于2011年6月至2014年7月进行手术。主要结局为无复发生存期（RFS）。次要结局为局部和远处复发部位、癌症特异性生存期（CSS）和总生存期（OS）。
未复发患者的ORC组中位随访时间为33.8个月（四分位间距[IQR]：20.5 - 45.4）；iRARC组为16.1个月（IQR：11.2 - 27.0）。ORC组和iRARC组在年龄、性别、膀胱切除术前T分期、膀胱切除术前分级或淋巴结清扫数量方面未观察到显著差异。由于术前化疗使用率较低（22.3%的ORC组 vs. 34.4%的iRARC组），ORC组中≥pT2期患者更多（64.8%的ORC组 vs. 38.9%的iRARC组），而pT0期患者更少（8.5%的ORC组 vs. 22.2%的iRARC组）。ORC组的手术切缘阳性率显著更高（19.3% vs. 8.2%；P = 0.042）。Kaplan - Meir分析显示，在24个月时，两组在RFS（69.5%的ORC组 vs. 78.8%的iRARC组）、癌症特异性生存期（80.9%的ORC组 vs. 84.4%的iRARC组）或OS（73.5%的ORC组 vs. 83.8%的iRARC组）方面无显著差异。Cox回归分析显示，RFS、癌症特异性生存期和OS不受膀胱切除技术的影响。ORC组和iRARC组在局部和远处RFS方面未观察到显著差异。
本研究发现ORC和iRARC在复发模式或肿瘤学结局方面无差异。复发转移部位各不相同，但与手术技术无关。
