Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
McMaster University, Hamilton, Ontario, Canada.
Eur Urol Focus. 2018 Dec;4(6):937-945. doi: 10.1016/j.euf.2017.03.011. Epub 2017 Mar 31.
Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC).
To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment.
DESIGN, SETTING, AND PARTICIPANTS: Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013.
RARC or ORC combined with perioperative chemotherapy for UBC.
Fisher's exact tests, χ tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors.
A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation.
In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint.
In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.
机器人辅助根治性膀胱切除术（RARC）与开放根治性膀胱切除术（ORC）联合围手术期化疗治疗肌层浸润性尿路上皮膀胱癌（UBC）的结果相比，知之甚少。
评估多模式治疗中 RARC 和 ORC 的手术和肿瘤学结果。
设计、设置和参与者：收集了 2000 年 1 月至 2013 年 7 月期间进行的 28 个中心的膀胱切除术数据。
RARC 或 ORC 联合围手术期 UBC 化疗。
使用 Fisher 精确检验、卡方检验和 Wilcoxon 秩和检验比较 RARC 和 ORC 组。Logistic 和 Cox 回归分析用于评估潜在的预后因素。
共分析了 688 例患者（n=603 例 ORC 和 n=85 例 RARC）；60.6%接受新辅助化疗，45.1%接受辅助化疗。两组患者的基线特征无显著差异。两组患者从手术到辅助化疗的中位时间均为 1.9 个月。RARC 组和 ORC 组的中位淋巴结切除数分别为 21（四分位间距 [IQR] 14-35）和 13（IQR 8-21）（p<0.001）；亚组分析结果一致。多变量分析显示，切缘阳性率（p=0.54 和 p=0.78）、新膀胱转流率（p=0.33 和 p=0.51）、无复发生存率（p=0.31 和 p=0.23）和总生存率（p=0.63 和 p=0.69）无差异。数据的回顾性是主要的局限性。
在这项研究中，RARC 和 ORC 在疗效结果或辅助化疗的实施能力方面没有差异。从肿瘤学角度来看，增加使用 RARC 是合理的。
在一项接受围手术期化疗治疗尿路上皮膀胱癌的患者回顾性研究中，我们发现机器人辅助根治性膀胱切除术（RARC）与开放根治性膀胱切除术（ORC）在关键结果方面没有差异。在多学科环境中，进行 RARC 似乎是合理的。
