1 Department of Urology, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
2 Section of Urology, Department of Surgery, University of Chicago , Chicago Illinois.
J Endourol. 2018 Jun;32(6):488-494. doi: 10.1089/end.2018.0079. Epub 2018 Apr 5.
To assess the frequency of minimally invasive radical cystectomy (MIRC) conversion to open surgery, what factors influence conversion, whether or not the benefits of MIRC vs open radical cystectomy (ORC) persist after conversion, and compare ORC and MIRC outcomes.
We performed a retrospective cohort study from the National Cancer Data Base (2010 to 2013) analyzing patients who underwent completed MIRC (n = 5750), converted MIRC (n = 245), and ORC (n = 12,053) without prior radiotherapy. Multivariable logistic and linear regression analyses were used to assess the association between covariates, open conversion as well as surgical approach, and secondary outcomes such as positive surgical margins (PSMs), use of lymphadenectomy, lymph node yield, hospital length of stay (LOS), and 30-day readmission.
Rates of conversion were independent of patient factors such as race, sex, use of neoadjuvant chemotherapy, and clinical stage. Conversion occurred in 245 of 5750 MIRCs (4.3%) and declined over time (5.8% in 2010 vs 3.2% in 2013, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.75, p = 0.001). MIRC was associated with fewer positive margins, higher lymph node yield, shorter LOS, and fewer readmissions compared with ORC, however, patients requiring open conversion had longer median hospital stays (8 days vs 7 days, p = 0.013), lower median lymph node yields (14 vs 17, p = 0.007), more PSMs (17% vs 11%, p = 0.006), and more 30-day readmissions (14% vs 9%, p = 0.008) compared to nonconverted. Converted MIRC had similar hospital LOS and 30-day readmission rates compared to ORC.
Open conversion during MIRC is uncommon and has decreased in recent years despite the rising use of MIRC. MIRC had better short-term outcomes compared with ORC. These benefits were negated with open conversion; however, outcomes were similar compared to planned ORC.
评估微创根治性膀胱切除术（MIRC）转为开放手术的频率、影响转化的因素、转化后 MIRC 与开放根治性膀胱切除术（ORC）的获益是否仍然存在，并比较 ORC 和 MIRC 的结果。
我们对国家癌症数据库（2010 年至 2013 年）中的患者进行了回顾性队列研究，分析了接受完整 MIRC（n=5750）、转化 MIRC（n=245）和 ORC（n=12053）且未接受过放射治疗的患者。多变量逻辑和线性回归分析用于评估协变量、开放转化以及手术方法与次要结果（如阳性切缘[PSM]、淋巴结清扫术的使用、淋巴结产量、住院时间[LOS]和 30 天再入院）之间的关联。
转换率与患者因素（如种族、性别、新辅助化疗的使用和临床分期）无关。在 5750 例 MIRC 中有 245 例（4.3%）发生了转化，且转化率随时间下降（2010 年为 5.8%，2013 年为 3.2%，比值比[OR]0.50，95%置信区间[CI]0.34-0.75，p=0.001）。与 ORC 相比，MIRC 具有更少的阳性切缘、更高的淋巴结产量、更短的 LOS 和更少的再入院，但需要开放转化的患者中位住院时间更长（8 天 vs 7 天，p=0.013）、中位淋巴结产量更低（14 个 vs 17 个，p=0.007）、PSM 更多（17% vs 11%，p=0.006）和 30 天再入院更多（14% vs 9%，p=0.008）。与非转化相比，转化后的 MIRC 具有相似的住院 LOS 和 30 天再入院率。
尽管 MIRC 的使用不断增加，但在 MIRC 期间进行开放转化仍然很少见，并且近年来有所减少。与 ORC 相比，MIRC 具有更好的短期结果。这些获益在开放转化后被否定；但是，与计划的 ORC 相比，结果是相似的。
