Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Surg Oncol. 2020 Jul;46(7):1347-1352. doi: 10.1016/j.ejso.2020.03.204. Epub 2020 Mar 14.
We tested whether frail patients may benefit from robot-assisted (RARC) relative to open radical cystectomy (ORC).
Frail patients treated with RC were identified within the National Inpatient Sample database (2008-2015). The effect of RARC vs. ORC was tested in five separate multivariable models predicting: complications, failure to rescue (FTR), in-hospital mortality, length of stay (LOS) and total hospital charges (THCs). As internal validity measure, analyses were repeated among non-frail patients. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics.
Of 11,578 RC patients, 3477 (30.0%) were frail. RARC was performed in 488 (14.0%) frail patients and 1386 (17.1%) non-frail patients. Among frail, RARC was only independently associated with shorter LOS (median 8 vs. 9 days, relative ratio [RR] 0.79, p < 0.001). Conversely, among non-frail, RARC was independently associated with lower complications (57.3 vs. 59.1%, odds ratio [OR] 0.82, p = 0.004) and shorter LOS (median 6 vs. 7 days, RR 0.88, p < 0.001), but also predicted higher THCs (+2850.3 US dollars, p = 0.001).
In frail patients, the use of RARC did not result in better short-term outcomes except for one-day advantage in LOS. Conversely, in non-frail patients, the use of RARC resulted in lower complication rates and shorter LOS at the cost of higher THCs. In consequence, the benefit of RARC appears relatively marginal in frail patients and our data do not suggest a clear and clinically-meaningful benefit of RARC over ORC in frail radical cystectomy population.
我们测试了虚弱患者是否可以从机器人辅助（RARC）中获益，而不是开放根治性膀胱切除术（ORC）。
在国家住院患者样本数据库（2008-2015 年）中，确定接受 RC 治疗的虚弱患者。在五个单独的多变量模型中测试了 RARC 与 ORC 的效果，这些模型预测了并发症、抢救失败（FTR）、住院死亡率、住院时间（LOS）和总住院费用（THCs）。作为内部有效性衡量标准，在非虚弱患者中重复了分析。所有模型都进行了加权，并根据聚类以及所有可用的患者和医院特征进行了调整。
在 11578 例 RC 患者中，3477 例（30.0%）为虚弱患者。在 488 例（14.0%）虚弱患者和 1386 例（17.1%）非虚弱患者中进行了 RARC。在虚弱患者中，RARC 仅与 LOS 缩短独立相关（中位数为 8 天 vs. 9 天，相对比值 [RR] 0.79，p < 0.001）。相反，在非虚弱患者中，RARC 与较低的并发症发生率独立相关（57.3% vs. 59.1%，比值比 [OR] 0.82，p = 0.004）和 LOS 缩短（中位数为 6 天 vs. 7 天，RR 0.88，p < 0.001），但也预测了更高的 THCs（增加 2850.3 美元，p = 0.001）。
在虚弱患者中，使用 RARC 除了 LOS 延长一天外，并没有带来更好的短期结果。相反，在非虚弱患者中，使用 RARC 可降低并发症发生率和 LOS，但其代价是更高的 THCs。因此，RARC 的益处对于虚弱患者来说相对较小，并且我们的数据并没有表明在虚弱的根治性膀胱切除术患者中，RARC 相对于 ORC 具有明显且有临床意义的益处。
