Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium.
Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Bologna, Bologna, Italy.
Eur Urol. 2021 Sep;80(3):358-365. doi: 10.1016/j.eururo.2021.02.029. Epub 2021 Feb 27.
The feasibility and safety of robot-assisted radical cystectomy (RARC) may be undermined by unfavorable preoperative surgical characteristics such as previous prostate surgery (PPS).
To compare perioperative outcomes for patients undergoing RARC with versus without a history of PPS.
DESIGN, SETTING, AND PARTICIPANTS: The study included 220 consecutive patients treated with RARC and pelvic lymph node dissection for bladder cancer at a single European tertiary centre. Of these, 43 had previously undergone PPS, defined as transurethral resection of the prostate/holmium laser enucleation of the prostate (n=21) or robot-assisted radical prostatectomy (n=22).
RARC in patients with a history of PPS.
Data on postoperative complications were collected according to the quality criteria for accurate and comprehensive reporting of surgical outcomes recommended by the European Association of Urology guidelines. Multivariable logistic, linear, and Poisson regression analyses were performed to test the effect of PPS on surgical outcomes.
Overall, 43 patients (20%) were treated with RARC after PPS. Operative time (OT) was longer in the PPS group (360 vs 330min; p<0.001). Patients with PPS experienced higher rates of intraoperative complications (19% vs 6.8%) and higher rates of 30-d (67% vs 39%), and Clavien-Dindo >3 (33% vs 16%) postoperative complications (all p<0.05). Moreover, the positive surgical margin (PSM) rate after RARC was higher in the PPS group (14% vs 4%; p=0.03). On multivariable analyses, PPS at RARC independently predicted higher risk of intraoperative (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.04-6.21; p=0.01) and 30-d complications (OR 2.26, 95% CI 1.05-5.22; p=0.02), as well as longer OT (relative risk [RR] 1.03, 95% CI 1.00-1.05; p=0.02) and length of stay (RR 1.13, 95% CI 1.02-1.26; p=0.02). Lack of randomization represents the main limitation.
RARC in patients with a history of PPS is feasible, but it is associated with a higher risk of complications and longer OT and length of stay. Moreover, higher PSM rates have been reported for these patients. Thus, measures aimed at improving surgical outcomes appear to be warranted.
We investigated the effect of previous prostate surgery (PPS) on surgical outcomes after robot-assisted removal of the bladder. We found that patients with PPS have a higher risk of complications and longer hospitalization after bladder removal. These patients deserve closer evaluation before this type of bladder operation.
机器人辅助根治性膀胱切除术（RARC）的可行性和安全性可能会因术前手术特征不佳而受到影响，例如先前的前列腺手术（PPS）。
比较 RARC 治疗伴有和不伴有前列腺手术史（PPS）的患者的围手术期结局。
设计、地点和参与者：这项研究纳入了在欧洲一家三级中心接受 RARC 和盆腔淋巴结清扫治疗膀胱癌的 220 例连续患者。其中 43 例患者有 PPS 史，定义为经尿道前列腺切除术/钬激光前列腺剜除术（n=21）或机器人辅助前列腺切除术（n=22）。
有 PPS 史的患者行 RARC。
根据欧洲泌尿外科学会指南中准确全面报告手术结果的质量标准，收集术后并发症数据。采用多变量逻辑、线性和泊松回归分析来检验 PPS 对手术结果的影响。
总体而言，43 例（20%）患者在 PPS 后接受了 RARC 治疗。PPS 组的手术时间（OT）更长（360 分钟比 330 分钟；p<0.001）。PPS 组术中并发症发生率更高（19%比 6.8%；p<0.05），30 天（67%比 39%）和 Clavien-Dindo >3 级（33%比 16%）术后并发症发生率更高（均 p<0.05）。此外，PPS 组 RARC 后的阳性切缘（PSM）率更高（14%比 4%；p=0.03）。多变量分析显示，PPS 独立预测术中（比值比[OR]2.10，95%置信区间[CI]1.04-6.21；p=0.01）和 30 天并发症（OR 2.26，95% CI 1.05-5.22；p=0.02）的风险更高，OT 更长（相对风险[RR]1.03，95% CI 1.00-1.05；p=0.02）和住院时间更长（RR 1.13，95% CI 1.02-1.26；p=0.02）。随机分组的缺乏是主要的局限性。
有 PPS 史的患者行 RARC 是可行的，但与并发症风险增加、OT 和住院时间延长有关。此外，这些患者的 PSM 率更高。因此，似乎有必要采取措施改善手术结果。
我们研究了先前的前列腺手术（PPS）对膀胱切除术后手术结果的影响。我们发现，有 PPS 的患者在膀胱切除术后并发症和住院时间更长。这些患者在接受这种类型的膀胱手术前需要更密切的评估。
