Division of Surgery and Interventional Science, University College London, London.
Academic Urology Unit, University of Sheffield, Sheffield, UK.
Curr Opin Urol. 2020 May;30(3):400-406. doi: 10.1097/MOU.0000000000000755.
Radical cystectomy is the definitive surgical treatment for aggressive bladder cancer. The robotic platform offers a new approach to radical cystectomy, but the benefits are unclear. This review examines the latest evidence, with a particular focus on developments in the last two years.
Prospective evaluations of open (ORC) and robot-assisted radical cystectomy (RARC) are emerging. The radical cystectomy in patients with bladder cancer trial reported in 2018 and demonstrated oncological noninferiority for both approaches and marginal shorter length of stays with RARC using an extracorporeal reconstruction. The trial confirmed prospective randomized comparisons are possible, and replicates observations from two earlier, smaller randomised controlled trials with longer follow-up. Although there has been significant traction to the intracorporeal approach to RARC, randomized trial evidence is awaited to show any benefit over ORC.
New evidence alludes to the noninferiority of the robotic platform in radical cystectomy in comparison to open surgery. There is minimal evidence of a clinically meaningful benefit. Until this is addressed, ORC remains the gold standard for the definitive surgical management of bladder cancer.
根治性膀胱切除术是侵袭性膀胱癌的明确手术治疗方法。机器人平台为根治性膀胱切除术提供了一种新的方法，但其益处尚不清楚。本综述检查了最新的证据，特别关注过去两年的发展。
正在出现开放（ORC）和机器人辅助根治性膀胱切除术（RARC）的前瞻性评估。2018 年报告的膀胱癌根治性切除术试验表明，两种方法的肿瘤学非劣效性，并且 RARC 采用体外重建的住院时间更短。该试验证实了前瞻性随机比较是可行的，并复制了两个较早的、较小的随机对照试验的观察结果，随访时间更长。尽管腔内方法的 RARC 得到了广泛关注，但仍需要随机试验证据表明其优于 ORC。
新的证据暗示机器人平台在根治性膀胱切除术方面与开放手术相比具有非劣效性。几乎没有证据表明存在有临床意义的获益。在这一点得到解决之前，ORC 仍然是膀胱癌确定性手术管理的金标准。
