经尿道切除术期间使用手术清单可提高非肌层浸润性膀胱癌患者的逼尿肌取材率并改善无复发生存率。

Use of surgical checklist during transurethral resection increases detrusor muscle collection rate and improves recurrence-free survival in patients with non-muscle-invasive bladder cancer.

作者信息

Taoka Rikiya, Tsunemori Hiroyuki, Matsuoka Yuki, Kohashiguchi Kana, Miura Takayoshi, Tohi Yoichiro, Miyauchi Yasuyuki, Kato Takuma, Ueda Nobufumi, Sugimoto Mikio

机构信息

Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan.

出版信息

Int J Urol. 2021 Jul;28(7):727-732. doi: 10.1111/iju.14548. Epub 2021 Mar 19.

DOI:10.1111/iju.14548

PMID:33742465

Abstract

OBJECTIVE

To elucidate the therapeutic benefits of using a surgical checklist during transurethral resection for non-muscle-invasive bladder cancer.

METHODS

A nine-item surgical checklist was established in January 2016 to assess disease risk and resection adequacy, and it was prospectively implemented into clinical practice. Patients diagnosed with non-muscle-invasive bladder cancer who underwent complete resection from January 2009 to August 2019 were included in this study. The presence of detrusor muscle in the transurethral resection specimen and the intravesical recurrence-free survival were compared between patients who underwent transurethral resection before and after surgical checklist implementation.

RESULTS

A total of 125 patients who underwent transurethral resection after surgical checklist implementation were reviewed and compared with 125 patients who underwent transurethral resection before surgical checklist implementation. The use of the surgical checklist led to an increase in the proportion of transurethral resection specimens containing detrusor muscle (92% vs 69.6%, P < 0.01) and a decrease in the recurrence rate (19.2% vs 49.6%, P < 0.01). Multivariate analysis showed that transurethral resection without a surgical checklist was an independent predictive factor influencing the absence of detrusor muscle in the transurethral resection specimen (odds ratio 4.78, P < 0.01) and intravesical recurrence (hazard ratio 1.92, 95% confidence interval 1.14-3.23; P = 0.01). Kaplan-Meier plots showed that the recurrence-free survival rate was significantly lower when the surgical checklist was not used (log-rank test result P < 0.01).

CONCLUSIONS

This study shows the therapeutic benefits of surgical checklist in improving the quality of resection during transurethral resection and reducing the recurrence rate in patients with non-muscle-invasive bladder cancer.

摘要

目的

阐明在非肌层浸润性膀胱癌经尿道切除术期间使用手术清单的治疗益处。

方法

2016年1月制定了一份包含九个项目的手术清单，以评估疾病风险和切除充分性，并前瞻性地应用于临床实践。本研究纳入了2009年1月至2019年8月期间被诊断为非肌层浸润性膀胱癌并接受完整切除的患者。比较了在手术清单实施前后接受经尿道切除术的患者的经尿道切除标本中逼尿肌的存在情况以及膀胱内无复发生存率。

结果

共回顾了125例在手术清单实施后接受经尿道切除术的患者，并与125例在手术清单实施前接受经尿道切除术的患者进行了比较。使用手术清单导致含有逼尿肌的经尿道切除标本的比例增加（92%对69.6%，P<0.01），复发率降低（19.2%对49.6%，P<0.01）。多变量分析显示，没有手术清单的经尿道切除术是影响经尿道切除标本中无逼尿肌（比值比4.78，P<0.01）和膀胱内复发（风险比1.92，95%置信区间1.14 - 3.23；P = 0.01）的独立预测因素。Kaplan-Meier曲线显示，不使用手术清单时无复发生存率显著较低（对数秩检验结果P<0.01）。