Khetrapal Pramit, Tan Wei Shen, Lamb Benjamin, Tan Melanie, Baker Hilary, Thompson James, Sridhar Ashwin, Kelly John D, Briggs Tim
Department of Urology, University College London Hospital at Westmoreland Street, 16-18 Westmoreland St, Marylebone, London, W1G 8PH, UK.
Division of Surgical and Interventional Sciences, University College London, 4th Floor, UCL Medical School Building, 21 University Street, London, WC1E 6AU, UK.
Curr Urol Rep. 2017 Aug;18(8):57. doi: 10.1007/s11934-017-0706-7.
Robot-assisted radical cystectomy (RARC) has been adopted widely in many centres, owed largely to the success of robot-assisted laparoscopic prostatectomy (RALP). It aims to replicate the oncological outcomes of open radical cystectomy (ORC), while providing a shorter recovery period. Despite this, previous RCTs have failed to show a benefit for RARC over ORC. These trials have compared extracorporeal RARC (eRARC) with ORC, which requires a further incision to mobilise the bowel for urinary reconstruction with an open technique. For intracorporeal RARC (iRARC), this urinary reconstruction is performed robotically without further incisions. There are theoretical benefits to this approach such as reduced recovery time for the bowel and reduced ileus rates, but no level 1 evidence currently exists to support this. While there has been an improvement in patient outcomes since the adoption of RARC, various other factors, such as enhanced recovery programmes and surgical learning curve, have made it difficult to attribute this solely to the robotic approach as many centres performing ORC have also shown similar improvements. In this review, we will discuss implementation of RARC as well as perioperative measures that have helped improve outcomes, offer a comparison of outcomes between ORC and RARC and highlight upcoming RCTs that may offer new evidence for or against a paradigm shift in the future of bladder cancer surgery.
机器人辅助根治性膀胱切除术（RARC）已在许多中心广泛采用，这在很大程度上归功于机器人辅助腹腔镜前列腺切除术（RALP）的成功。它旨在复制开放性根治性膀胱切除术（ORC）的肿瘤学疗效，同时缩短恢复时间。尽管如此，以往的随机对照试验未能显示RARC比ORC更具优势。这些试验将体外RARC（eRARC）与ORC进行了比较，ORC需要进一步切开以游离肠道，采用开放技术进行尿路重建。对于体内RARC（iRARC），这种尿路重建通过机器人进行，无需进一步切开。这种方法在理论上有一些好处，如肠道恢复时间缩短和肠梗阻发生率降低，但目前尚无一级证据支持这一点。虽然自采用RARC以来患者的治疗效果有所改善，但其他各种因素，如强化康复计划和手术学习曲线，使得很难将这完全归因于机器人手术方法，因为许多进行ORC的中心也显示出类似的改善。在本综述中，我们将讨论RARC的实施以及有助于改善治疗效果的围手术期措施，比较ORC和RARC的治疗效果，并重点介绍可能为膀胱癌手术未来的范式转变提供支持或反对新证据的即将开展的随机对照试验。
