Li Amy Y, Filson Christopher P, Hollingsworth John M, He Chang, Weizer Alon Z, Hollenbeck Brent K, Gilbert Scott M, Hafez Khaled S, Lee Cheryl T, Dunn Rodney L, Montgomery Jeffrey S
University of Michigan, Ann Arbor, MI, USA.
Emory University, Atlanta, GA, USA.
Surg Innov. 2016 Dec;23(6):598-605. doi: 10.1177/1553350616656284. Epub 2016 Jun 28.
Background Robotic-assisted radical cystectomy (RARC) is gaining traction as a surgical approach, but there are limited data on patient-reported outcomes for this technique compared to open radical cystectomy (ORC). Objective To compare health-related quality of life (HRQoL) and short-term convalescence among bladder cancer patients who underwent ORC and RARC. Methods Review of a single-institution bladder cancer database was conducted. Baseline and postoperative HRQoL was evaluated using the Bladder Cancer Index (BCI) for 324 patients who had ORC (n = 267) or RARC (n = 57) between 2008 and 2012. The BCI assesses function and bother in urinary, bowel, and sexual domains. Among 87 distinct patients (ORC n = 67, RARC n = 20), we also evaluated short-term postoperative convalescence using the Convalescence and Recovery Evaluation (CARE) questionnaire. Our primary outcomes were HRQoL within 12 months and short-term convalescence within 6 weeks following cystectomy. We fit generalized estimating equation regression models to estimate longitudinal changes in BCI scores within domains, and CARE domain score differences were tested with Wilcoxon rank-sum tests. Results Clinical characteristics and baseline BCI/CARE scores were similar between the 2 groups (all P > .05). Within 1 year after surgery, recovery of HRQoL across all BCI domains was comparable, with scores nearly returning to baseline at 1 year for all patients. CARE scores at 4 weeks revealed that patients treated with ORC had better pain (29.1 vs 20.0, P = .02) domain scores compared to RARC. These differences abated by week 6. Conclusions HRQoL recovery and short-term convalescence were similar in this cohort following ORC and RARC.
背景 机器人辅助根治性膀胱切除术（RARC）作为一种手术方法越来越受到关注，但与开放性根治性膀胱切除术（ORC）相比，关于该技术患者报告结局的数据有限。目的 比较接受ORC和RARC的膀胱癌患者的健康相关生活质量（HRQoL）和短期康复情况。方法 对单一机构的膀胱癌数据库进行回顾。使用膀胱癌指数（BCI）对2008年至2012年间接受ORC（n = 267）或RARC（n = 57）的324例患者的基线和术后HRQoL进行评估。BCI评估泌尿、肠道和性功能及困扰情况。在87例不同患者（ORC n = 67，RARC n = 20）中，我们还使用康复与恢复评估（CARE）问卷评估术后短期康复情况。我们的主要结局是膀胱切除术后12个月内HRQoL和6周内短期康复情况。我们采用广义估计方程回归模型来估计各领域BCI评分的纵向变化，并用Wilcoxon秩和检验来检验CARE领域评分差异。结果 两组患者的临床特征和基线BCI/CARE评分相似（所有P >.05）。术后1年内，所有BCI领域的HRQoL恢复情况相当，所有患者的评分在1年时几乎恢复到基线水平。4周时的CARE评分显示，与RARC相比，接受ORC治疗的患者疼痛领域评分更好（29.1对20.0，P =.02）。这些差异在第6周时消失。结论 在该队列中，ORC和RARC后的HRQoL恢复和短期康复情况相似。
