Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
J Urol. 2018 Jun;199(6):1518-1525. doi: 10.1016/j.juro.2017.12.061. Epub 2018 Jan 4.
We compared outcomes between robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection in patients without bulky nodal metastasis in a tandem contemporary cohort.
We retrospectively analyzed a prospectively maintained hospital registry of 51 patients who underwent robot-assisted video endoscopic inguinal lymphadenectomy and 100 treated with open inguinal lymph node dissection from 2012 to 2016 for groins without bulky nodal metastasis and who had a minimum 9-month followup. Complications were graded by the Clavien-Dindo classification, and nodal yield and disease recurrence during followup were assessed. Elastic net regression was used to select variables associated with major complications (Clavien 3a or greater) for multivariable analysis of plausible factors, including patient age, diabetes, body mass index, smoking, nodal stage, surgery type, sartorius transposition, saphenous vein transection and adjuvant radiotherapy. Penalized likelihood logistic regression methods were used for multivariate analysis to ascertain final effect sizes while accounting for sparse data bias.
Robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection had comparable median lymph node yields (13 vs 12.5). No patient experienced recurrence during the median followup of 40 months. Robot-assisted video endoscopic inguinal lymphadenectomy was associated with significantly lower hospital stay, days needing a drain in situ, incidence of major complications, edge necrosis, flap necrosis and severe limb edema. On multivariable analysis pathological nodal stage (OR 2.8, 95% CI 1.1-6.8, p = 0.027) and open inguinal lymph node dissection (OR 7.5, 95% CI 1.3-43, p = 0.024) emerged as independent risk factors associated with an increased risk of major complications.
Robot-assisted video endoscopic inguinal lymphadenectomy is a feasible technique which allows for a similar nodal yield while being associated with lower morbidity than open inguinal lymph node dissection in patients without bulky groin adenopathy.
我们比较了无大体积淋巴结转移患者中机器人辅助视频内镜腹股沟淋巴结切除术和开放腹股沟淋巴结清扫术的结果，这是一项在连续的当代队列中的研究。
我们回顾性分析了 2012 年至 2016 年期间，51 例因腹股沟无大体积淋巴结转移而行机器人辅助视频内镜腹股沟淋巴结切除术和 100 例开放腹股沟淋巴结清扫术的患者的前瞻性维护医院登记资料。所有患者均有至少 9 个月的随访。并发症分级采用 Clavien-Dindo 分类，评估随访期间的淋巴结产量和疾病复发情况。弹性网回归用于选择与主要并发症（Clavien 3a 或更高）相关的变量，进行多变量分析，包括患者年龄、糖尿病、体重指数、吸烟、淋巴结分期、手术类型、缝匠肌移位、隐静脉切开术和辅助放疗。惩罚似然逻辑回归方法用于多变量分析，以确定最终的效应大小，同时考虑稀疏数据偏差。
机器人辅助视频内镜腹股沟淋巴结切除术和开放腹股沟淋巴结清扫术的中位淋巴结产量相似（13 对 12.5）。中位随访 40 个月期间无患者复发。机器人辅助视频内镜腹股沟淋巴结切除术与较低的住院时间、原位引流天数、主要并发症发生率、边缘坏死、皮瓣坏死和严重肢体水肿相关。多变量分析显示，病理淋巴结分期（OR 2.8，95%CI 1.1-6.8，p = 0.027）和开放腹股沟淋巴结清扫术（OR 7.5，95%CI 1.3-43，p = 0.024）是与主要并发症风险增加相关的独立危险因素。
机器人辅助视频内镜腹股沟淋巴结切除术是一种可行的技术，在无大体积腹股沟淋巴结病患者中，与开放腹股沟淋巴结清扫术相比，具有相似的淋巴结产量，且发病率较低。
