Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
Int J Clin Oncol. 2020 Jul;25(7):1385-1392. doi: 10.1007/s10147-020-01677-y. Epub 2020 Apr 18.
The incidence of atypical oncologic failure in patients with bladder cancer, including peritoneal carcinomatosis, and recurrences at the port site and soft tissue after laparoscopic and robot-assisted radical cystectomy are not well characterized.
We retrospectively reviewed the records of 52, 51, and 12 patients who underwent open, laparoscopic, and robot-assisted radical cystectomy, respectively, for bladder cancer from 2007 to 2018 at our institution. We identified techniques associated with atypical oncologic failure.
The median follow-up period was 29 months. Among the 115 patients, 29 (25%) experienced oncological recurrences, and 7 (6%), 12 (10%), and 23 (20%) had atypical, local, and distant recurrences, respectively. The laparoscopic and robot-assisted radical cystectomy groups had significantly higher incidences of total atypical oncologic failure than the open radical cystectomy group (p = 0.013), including six, one, and two patients with peritoneal carcinomatosis, port site carcinomatosis, and soft tissue involvement, respectively. All 7 patients with atypical oncologic failure died of cancer; the median time from surgery to death was 9.3 months. All these patients were cT ≧ 3 and had grade 3 disease. In three patients (43%), the pathological tissue contained variants other than urothelial carcinoma. Five (71%) were among the initial twenty patients. Four patients (57%) had histories of intraoperative urine spillage or bladder perforation during transurethral resection.
Patients with cT ≧ 3 stage, with pathological variants other than urothelial carcinoma, and those undergoing procedures that lead to extravesical dissemination should avoid laparoscopic radical cystectomy when the procedures are first introduced.
膀胱癌患者的非典型肿瘤学失败发生率，包括腹膜癌病、腹腔镜和机器人辅助根治性膀胱切除术后端口部位和软组织复发，尚未得到很好的描述。
我们回顾性分析了 2007 年至 2018 年在我院接受开放、腹腔镜和机器人辅助根治性膀胱切除术的 52、51 和 12 例膀胱癌患者的病历。我们确定了与非典型肿瘤学失败相关的技术。
中位随访时间为 29 个月。在 115 例患者中，29 例（25%）发生了肿瘤学复发，7 例（6%）、12 例（10%）和 23 例（20%）分别发生了非典型、局部和远处复发。腹腔镜和机器人辅助根治性膀胱切除术组的总非典型肿瘤学失败发生率明显高于开放根治性膀胱切除术组（p=0.013），包括 6 例、1 例和 2 例腹膜癌病、端口部位癌病和软组织浸润。所有 7 例非典型肿瘤学失败的患者均死于癌症；从手术到死亡的中位时间为 9.3 个月。所有这些患者均为 cT≧3 且疾病分级为 3 级。在 3 例患者（43%）中，病理组织含有除尿路上皮癌以外的变异。其中 5 例（71%）是在最初的 20 例患者中。4 例（57%）有经尿道切除术时术中尿液外溢或膀胱穿孔的病史。
当首次引入手术时，对于 cT≧3 期、病理组织有除尿路上皮癌以外的变异的患者，以及那些进行导致膀胱外扩散的手术的患者，应避免腹腔镜根治性膀胱切除术。
