Department of Urology, University of Virginia, Charlottesville, VA, USA.
Ann Surg Oncol. 2018 Sep;25(9):2550-2562. doi: 10.1245/s10434-018-6557-8. Epub 2018 Jun 14.
We performed a comparative survival analysis of patients undergoing robotic-assisted versus laparoscopic or open surgery for upper tract urothelial carcinoma (UTUC).
Patients diagnosed with non-metastatic UTUC undergoing removal of the kidney and/or ureter were identified using Medicare-linked Surveillance, Epidemiology, and End Results Program data (2004-2013). Patients aged 65-85 years were categorized based on surgical approach (open, laparoscopic, or robotic-assisted). Kaplan-Meier methods were used to determine survival (overall and cancer-specific) and intravesical recurrence rates, the former using a propensity score-weighted model. Independent predictors of survival were determined using multivariable Cox proportional hazards regression analysis.
We identified a total of 3801 patients meeting the final inclusion criteria: open (n = 1862), laparoscopic (n = 1624), and robotic (n = 315). Robotic surgery was associated with the shortest length of hospital stay (p < 0.001) but highest in-hospital charges (p < 0.001), with no difference in readmission rates (p = 0.964). No difference was found in overall or cancer-specific survival in the robotic cohort when compared with open or laparoscopic surgery. In addition, no difference in the rate of intravesical recurrence was noted in robotic-assisted laparoscopy compared with the other groups. The sole predictor of improved survival was extent of lymphadenectomy, which was highest in the robotic cohort.
Using a large, population-based cancer database, there was no survival difference when a robotic-assisted approach was utilized in patients undergoing surgery for UTUC. These findings are important with the increased use of robotic surgery in the management of UTUC.
我们对接受机器人辅助手术与腹腔镜或开放手术治疗上尿路上皮癌（UTUC）的患者进行了生存分析比较。
使用 Medicare 相关的监测、流行病学和最终结果计划（SEER）数据（2004-2013 年）确定诊断为非转移性 UTUC 并接受肾脏和/或输尿管切除的患者。根据手术方法（开放、腹腔镜或机器人辅助）将 65-85 岁的患者进行分类。Kaplan-Meier 法用于确定生存（总生存和癌症特异性生存）和膀胱内复发率，前者采用倾向评分加权模型。使用多变量 Cox 比例风险回归分析确定生存的独立预测因素。
我们共确定了符合最终纳入标准的 3801 例患者：开放组（n=1862）、腹腔镜组（n=1624）和机器人组（n=315）。机器人手术的住院时间最短（p<0.001），但住院费用最高（p<0.001），再入院率无差异（p=0.964）。与开放或腹腔镜手术相比，机器人组的总生存和癌症特异性生存无差异。此外，机器人辅助腹腔镜组与其他组相比，膀胱内复发率无差异。唯一提高生存的预测因素是淋巴结清扫的范围，机器人组最高。
使用大型基于人群的癌症数据库，在接受 UTUC 手术的患者中使用机器人辅助方法时，生存无差异。这些发现对于机器人手术在 UTUC 管理中的广泛应用非常重要。
