Mita Koji, Kobatake Kohei, Ohara Shinya, Kato Masao
Department of Urology, Hiroshima City Asa Hospital.
Nihon Hinyokika Gakkai Zasshi. 2018;109(1):1-6. doi: 10.5980/jpnjurol.109.1.
(Objective) To evaluate the utility of laparoscopic radical cystectomy (LRC), we retrospectively compared the background factors and perioperative parameters of LRC with those of open radical cystectomy (ORC). (Patients and methods) The study cohort consisted of 116 consecutive patients who underwent radical cystectomy by LRC (n=59) or ORC (n=57). The background factors and perioperative parameters were compared between LRC and ORC. (Results) The patients consisted of 103 men and 13 women with a median age of 69 years and median BMI of 23.0. Their clinical stage was as follows, ≤T1: 19 cases, T2: 69 cases, T3: 25 cases and T4: 3 cases, respectively.While the patients' age at the time of LRC was significantly higher than that of ORC (71.3 yrs vs. 66.2 yrs, P<0.001) and the ASA physical status of LRC was significantly higher than that of ORC (P=0.028), the other background factors were not different between the two groups.Although there was no difference in the total operating time between LRC and ORC, the estimated blood loss for LRC was significantly less than that for ORC (372.3 ml vs. 2,134.5 ml, P<0.001) and the duration of the postoperative hospital stay for LRC was significantly shorter than that for ORC (23.5 days vs. 36.9 days, P<0.001).There were no significant differences in the pathological findings, of the postoperative recurrence-free rate or cancer-specific survival rate between the LRC and ORC groups. In multivariate analysis, only pN+was an independent predictive factor of postoperative recurrence. (Conclusion) This study showed that LRC is less invasive and can lead to similar oncological outcomes compared with ORC.
（目的）为评估腹腔镜根治性膀胱切除术（LRC）的效用，我们回顾性比较了LRC与开放性根治性膀胱切除术（ORC）的背景因素和围手术期参数。（患者与方法）研究队列包括116例连续接受LRC（n = 59）或ORC（n = 57）根治性膀胱切除术的患者。比较了LRC和ORC之间的背景因素和围手术期参数。（结果）患者包括103名男性和13名女性，中位年龄69岁，中位BMI为23.0。其临床分期如下，≤T1：19例，T2：69例，T3：25例，T4：3例。虽然LRC患者的年龄显著高于ORC患者（71.3岁对66.2岁，P<0.001），且LRC的美国麻醉医师协会身体状况显著高于ORC（P = 0.028），但两组之间的其他背景因素并无差异。虽然LRC和ORC的总手术时间无差异，但LRC的估计失血量显著少于ORC（372.3毫升对2134.5毫升，P<0.001），且LRC的术后住院时间显著短于ORC（23.5天对36.9天，P<0.001）。LRC组和ORC组在病理结果、术后无复发生存率或癌症特异性生存率方面无显著差异。在多变量分析中，只有pN+是术后复发的独立预测因素。（结论）本研究表明，与ORC相比，LRC的侵入性较小，且能带来相似的肿瘤学结果。
