Owyong Michael, Koru-Sengul Tulay, Miao Feng, Razdan Shirin, Moore Kevin J, Alameddine Mahmoud, Punnen Sanoj, Parekh Dipen J, Ritch Chad R, Gonzalgo Mark L
Department of Urology, University of Miami Miller School of Medicine, Miami, FL.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
Urol Oncol. 2019 Dec;37(12):870-876. doi: 10.1016/j.urolonc.2019.07.018. Epub 2019 Aug 21.
We assessed the impact of open or minimally-invasive partial cystectomy on surgical margin status in a nationwide hospital-based cohort.
Patients who underwent partial cystectomy from 2010 to 2014 were identified in the National Cancer Data Base. The primary outcome was surgical margin status. A multivariable logistic regression model was fitted to identify patient, hospital, and surgical factors associated with positive surgical margins (PSMs).
Partial cystectomy was performed in 1,118 patients via open (n = 715, 64%), laparoscopic (n = 209, 19%), and robotic (n = 194, 17%) approaches. Overall, 220 (19.7%) patients had PSMs. The PSM rate by surgical approach was 19.6% for open, 18.2% for laparoscopic, and 21.6% for robotic (P = 0.678). Compared to open partial cystectomy, the laparoscopic (aOR 1.06, 95%CI 0.70-1.60, P = 0.782), and robotic (aOR 1.28, 95%CI 0.85-1.91, P = 0.235) approaches were not significantly different in terms of PSM rate. There were higher odds of PSMs in non-Hispanic blacks (aOR 1.93, 95%CI 1.09-3.39, P = 0.023) compared to non-Hispanic whites, and in patients with muscle invasive bladder cancer (aOR 3.28, 95%CI 2.00-5.37, P < 0.001) or tumor size ≥ 3 cm (aOR 1.67, 95%CI 1.21-2.30, P = 0.002). Tumors in a dome/urachal location had lower odds of a PSM compared to tumors in a nondome/urachal location (aOR 0.67, 95%CI 0.47-0.94, P = 0.022).
Our results suggest that partial cystectomy using a laparoscopic or robotic-assisted approach is not associated with an increased risk of PSMs compared to open partial cystectomy.
我们在一个全国性的基于医院的队列中评估了开放性或微创性部分膀胱切除术对手术切缘状态的影响。
在国家癌症数据库中识别出2010年至2014年接受部分膀胱切除术的患者。主要结局是手术切缘状态。采用多变量逻辑回归模型来识别与阳性手术切缘（PSM）相关的患者、医院和手术因素。
1118例患者接受了部分膀胱切除术，手术方式包括开放性手术（n = 715，64%）、腹腔镜手术（n = 209，19%）和机器人手术（n = 194，17%）。总体而言，220例（19.7%）患者存在PSM。按手术方式划分的PSM率，开放性手术为19.6%，腹腔镜手术为18.2%，机器人手术为21.6%（P = 0.678）。与开放性部分膀胱切除术相比，腹腔镜手术（调整后比值比[aOR]1.06，95%置信区间[CI]0.70 - 1.60，P = 0.782）和机器人手术（aOR 1.28，95%CI 0.85 - 1.91，P = 0.235）在PSM率方面无显著差异。与非西班牙裔白人相比，非西班牙裔黑人出现PSM的几率更高（aOR 1.93，95%CI 1.09 - 3.39，P = 0.023），肌肉浸润性膀胱癌患者（aOR 3.28，95%CI 2.00 - 5.37，P < 0.001）或肿瘤大小≥3 cm的患者（aOR 1.67，95%CI 1.21 - 2.30，P = 0.002）也是如此。与非穹顶/脐尿管部位的肿瘤相比，穹顶/脐尿管部位的肿瘤出现PSM的几率更低（aOR 0.67，95%CI 0.47 - 0.94，P = 0.022）。
我们的结果表明，与开放性部分膀胱切除术相比，采用腹腔镜或机器人辅助方法进行部分膀胱切除术并不会增加PSM的风险。
