北美和欧洲部分中心机器人辅助根治性膀胱切除术与开放性根治性膀胱切除术使用趋势的差异以及围手术期结局随时间的变化：一项国际多中心合作研究
Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration.
作者信息
Zamboni Stefania, Soria Francesco, Mathieu Romain, Xylinas Evanguelos, Abufaraj Mohammad, D Andrea David, Tan Wei Shen, Kelly John D, Simone Giuseppe, Gallucci Michele, Meraney Anoop, Krishna Suprita, Konety Badrinath R, Antonelli Alessandro, Simeone Claudio, Baumeister Philipp, Mattei Agostino, Briganti Alberto, Gallina Andrea, Montorsi Francesco, Rink Michael, Aziz Atiqullah, Karakiewicz Pierre I, Rouprêt Morgan, Koupparis Anthony, Scherr Douglas S, Ploussard Guillaume, Sooriakumaran Prasanna, Shariat Shahrokh F, Moschini Marco
机构信息
Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria.
出版信息
BJU Int. 2019 Oct;124(4):656-664. doi: 10.1111/bju.14791. Epub 2019 Jun 2.
OBJECTIVES
To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres.
MATERIALS AND METHODS
We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables.
RESULTS
Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost.
CONCLUSION
The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
目的
比较北美和欧洲部分中心机器人辅助根治性膀胱切除术（RARC）的使用趋势以及围手术期结局随时间的变化。
材料与方法
我们对2006年至2018年间在北美和欧洲12个中心接受开放性根治性膀胱切除术（ORC）或RARC治疗膀胱癌的2401例患者进行了回顾性评估。我们使用Kruskal-Wallis检验和卡方检验来评估连续变量和分类变量之间的差异。
结果
总体而言，49.5%的患者接受了RARC，51.5%的患者接受了ORC。RARC成为当代患者中最常施行的手术，从2006 - 2008年的29%增至2015 - 2018年的54%（P < 0.001）。在北美中心，自2006年起RARC的使用高于ORC，且随时间保持稳定，而在欧洲中心，其使用从2%呈指数增长至50%。两组中接受RARC的患者T分期较晚的比例更低（P < 0.001），美国麻醉医师协会评分更低（P < 0.05），失血量更少（P = 0.001），住院时间更短（P < 0.05）。早期并发症方面未发现差异。欧洲中心接受RARC治疗的患者早期再入院率和再次手术率更差；然而，仅考虑当代患者时，统计学意义消失。
结论
本研究表明，自引入以来RARC的使用持续增加，在最新系列中超过了ORC。自引入北美中心以来，RARC的施行频率高于ORC且随时间基本保持稳定，而在欧洲中心其使用呈指数增长。北美和欧洲中心在RARC/ORC使用趋势以及围手术期结局随时间的变化方面存在差异，这可归因于RARC在前者比后者更早引入和推广。
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