Tamhankar Ashwin Sunil, Ahluwalia Puneet, Patil Saurabh Ramesh, Nambiath Sujata, Gautam Gagan
Department of Urooncology, Max Institute of Cancer Care, New Delhi, India.
Indian J Urol. 2020 Jan-Mar;36(1):37-43. doi: 10.4103/iju.IJU_207_19.
The objective of this study was to evaluate the perioperative outcomes of patients undergoing robot-assisted radical cystectomy (RARC) with intracorporeal ileal conduit (IIC) urinary diversion treated in line with the enhanced recovery after surgery (ERAS) protocol.
After approval from the institutional ethics committee, we conducted an analysis of a prospectively maintained database of patients undergoing RARC + IIC using ERAS protocol by a single surgical team with the da Vinci Xi system from March 2016 till December 2018. To minimize the effect of the learning curve of this complex procedure, we excluded the first thirty patients from analysis.
Thirty-five consecutive patients (33 males and 2 females) with a median age of 69 years (range: 50-82) were evaluated. The median total console time and console time for diversion were 253 min (range: 191-370) and 80 min (range: 65-90), respectively. The median estimated blood loss was 300 cc (range: 50-500). The median length of stay was 8 days (range: 4-30). Per-urethral pelvic drain was removed at a median of 2 days (range: 1-17). Overall, complications occurred in 16/35 (45.7%) patients, of which major complications (≥Grade 3) were seen in 5/35 (14.3%) patients, without any 90-day mortality. The median follow-up for the cohort was 14 months (1-34).
While the initial outcomes of this combined treatment strategy appear promising in terms of complication rates and perioperative parameters, greater insight is required from multi-institutional data sets and prospective comparative studies to establish the true value of RARC + IIC and ERAS protocol for bladder cancer.
本研究的目的是评估按照术后加速康复（ERAS）方案接受机器人辅助根治性膀胱切除术（RARC）并采用体内回肠代膀胱术（IIC）进行尿流改道的患者的围手术期结局。
经机构伦理委员会批准后，我们对一个前瞻性维护的数据库进行了分析，该数据库收录了2016年3月至2018年12月期间由一个手术团队使用达芬奇Xi系统按照ERAS方案接受RARC + IIC手术的患者。为尽量减少这一复杂手术学习曲线的影响，我们将前30例患者排除在分析之外。
对35例连续患者（33例男性和2例女性）进行了评估，中位年龄为69岁（范围：50 - 82岁）。中位总控制台时间和尿流改道控制台时间分别为253分钟（范围：191 - 370分钟）和80分钟（范围：65 - 90分钟）。中位估计失血量为300毫升（范围：50 - 500毫升）。中位住院时间为8天（范围：4 - 30天）。经尿道盆腔引流管中位拔除时间为2天（范围：1 - 17天）。总体而言，16/35（45.7%）的患者发生了并发症，其中5/35（14.3%）的患者出现了严重并发症（≥3级），无90天内死亡病例。该队列的中位随访时间为14个月（1 - 34个月）。
虽然这种联合治疗策略的初步结局在并发症发生率和围手术期参数方面看起来很有前景，但需要多机构数据集和前瞻性对照研究提供更深入的见解，以确定RARC + IIC和ERAS方案对膀胱癌的真正价值。
