Esquinas C, Alonso J M, Mateo E, Dotor A, Martín A M, Dorado J F, Arance I, Angulo J C
Servicio de Urología, Hospital Universitario de Getafe, Madrid, España.
Departamento Clínico, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
Actas Urol Esp (Engl Ed). 2018 Mar;42(2):94-102. doi: 10.1016/j.acuro.2017.04.004. Epub 2017 Jun 16.
Laparoscopic radical cystectomy with lymphadenectomy and urinary diversion is an increasingly widespread operation. Studies are needed to support the oncological effectiveness and safety of this minimally invasive approach.
A nonrandomised, comparative prospective study between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) was conducted in a university hospital. The main objective was to compare cancer-specific survival. The secondary objective was to compare the surgical results and complications according to the Clavien-Dindo scale.
We treated 156 patients with high-grade invasive bladder cancer with either ORC (n=70) or LRC (n=86). The mean follow-up was 33.5±23.8 (range 12-96) months. The mean age was 66.9+9.4 years, and the male to female ratio was 19:1. Both groups were equivalent in age, stage, positive lymph nodes, in situ carcinoma, preoperative obstructive uropathy, adjuvant chemotherapy and type of urinary diversion. There were no differences between the groups in terms of cancer-specific survival (log-rank; P=.71). The histopathology stage was the only independent variable that predicted the prognosis. The hospital stay (P=.01) and operative transfusion rates (P=.002) were less for LRC. The duration of the surgery was greater for LRC (P<.001). There were no differences in the total complications rate (p=.62) or major complications (P=.69). The risk of evisceration (P=.02), surgical wound infection (P=.005) and pneumonia (P=.017) was greater for ORC. The risk of rectal lesion (P=.017) and urethrorectal fistulae (P=.065) was greater for LRC.
LRC is an equivalent treatment to ORC in terms of oncological efficacy and is advantageous in terms of transfusion rates and hospital stays but not in terms of operating room time and overall safety. Studies are needed to better define the specific safety profile for each approach.
腹腔镜根治性膀胱切除术联合淋巴结清扫术及尿流改道术是一种应用日益广泛的手术。需要开展研究以支持这种微创方法的肿瘤学疗效和安全性。
在一家大学医院开展了一项开放性根治性膀胱切除术（ORC）与腹腔镜根治性膀胱切除术（LRC）的非随机、比较性前瞻性研究。主要目的是比较癌症特异性生存率。次要目的是根据Clavien-Dindo分级标准比较手术结果及并发症。
我们采用ORC（n = 70）或LRC（n = 86）治疗了156例高级别浸润性膀胱癌患者。平均随访时间为33.5±23.8（范围12 - 96）个月。平均年龄为66.9 + 9.4岁，男女比例为19:1。两组在年龄、分期、阳性淋巴结、原位癌、术前梗阻性尿路病、辅助化疗及尿流改道类型方面相当。两组在癌症特异性生存率方面无差异（对数秩检验；P = 0.71）。组织病理学分期是预测预后的唯一独立变量。LRC的住院时间（P = 0.01）和术中输血率（P = 0.002）更低。LRC的手术时间更长（P < 0.001）。总并发症发生率（P = 0.62）或严重并发症发生率（P = 0.69）无差异。ORC发生脏器脱出（P = 0.02）、手术切口感染（P = 0.005）及肺炎（P = 0.017）的风险更高。LRC发生直肠损伤（P = 0.017）及尿道直肠瘘（P = 0.065）的风险更高。
就肿瘤学疗效而言，LRC与ORC疗效相当，在输血率和住院时间方面具有优势，但在手术时间和总体安全性方面并非如此。需要开展研究以更好地明确每种方法的具体安全性特征。
