Department of Molecular Medicine and Surgery Section of Urology, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
BJU Int. 2018 May;121(5):752-757. doi: 10.1111/bju.14112. Epub 2018 Jan 19.
To describe the evolution in radical cystectomy (RC) care over 11 years at a referral centre.
The clinical data of patients undergoing either open RC (ORC) or robot-assisted RC (RARC) for cT1-4aN0M0 bladder cancer (BCa) at our centre between January 2006 and December 2016 were retrospectively evaluated. Crude and propensity score-weighted log-binomial regression analyses were conducted to assess the association between pre- and peri-operative variables and the risk of reoperation, intensive care unit (ICU) admission and death <90 days after RC.
A total of 814 patients were considered. The percentage of RARCs performed increased (from 10% to 100%) between 2006 and 2013. Overall, 29% of the patients received neoadjuvant chemotherapy (12-37% from 2006 to 2016). Despite no differences in terms of operating time, pelvic lymph node dissection (PLND) was more commonly attempted during RARC and extended PLND was more frequently performed in the RARC group (72% vs 19%; P < 0.001). Ileal conduit was the preferred urinary diversion in both groups, and more patients in the RARC group underwent neobladder construction (34% vs 14%; P < 0.001). The overall rates of re-intervention, ICU admission and death within 90 days of RC were 8.9%, 5.4% and 2.9%, respectively. On crude analysis, RARC was associated with a reduced risk of ICU admission (relative risk [RR] 0.42, 95% confidence interval [CI] 0.23-0.77; P = 0.005), reintervention (RR 0.58, 95% CI 0.37-0.90; P = 0.015) and death (RR 0.37, 95% CI 0.16-0.85; P = 0.020); however, these risk reductions were not statistically significant on weighted analyses.
The introduction of RARC has coincided with a reduction in the rate of ICU admission, reoperation and death within 90 days of surgery, without compromising operating time, PLND extent or neobladder utilization.
描述在一家转诊中心，11 年间根治性膀胱切除术（RC）护理的演变。
回顾性分析 2006 年 1 月至 2016 年 12 月期间在本中心接受开放 RC（ORC）或机器人辅助 RC（RARC）治疗 cT1-4aN0M0 膀胱癌（BCa）的患者的临床数据。采用未经调整和倾向评分加权的对数二项式回归分析，评估术前和围手术期变量与再手术、重症监护病房（ICU）入住和 RC 后 90 天内死亡风险之间的关系。
共纳入 814 例患者。RARC 的比例（从 2006 年的 10%增加到 2013 年的 100%）增加。总体而言，29%的患者接受了新辅助化疗（2006 年至 2016 年为 12-37%）。尽管手术时间无差异，但 RARC 期间更常尝试进行盆腔淋巴结清扫（PLND），RARC 组更常进行广泛 PLND（72%对 19%；P<0.001）。两组均首选回肠造口术作为尿路改道，RARC 组更多患者行新膀胱构建（34%对 14%；P<0.001）。RC 后 90 天内再干预、入住 ICU 和死亡的总体发生率分别为 8.9%、5.4%和 2.9%。在未经调整的分析中，RARC 与 ICU 入住风险降低相关（相对风险 [RR] 0.42，95%置信区间 [CI] 0.23-0.77；P=0.005）、再干预（RR 0.58，95% CI 0.37-0.90；P=0.015）和死亡（RR 0.37，95% CI 0.16-0.85；P=0.020）；然而，在加权分析中，这些风险降低并不具有统计学意义。
RARC 的引入降低了 RC 后 90 天内 ICU 入住率、再手术率和死亡率，同时不影响手术时间、PLND 范围或新膀胱利用。
