Walz Simon, Aslani Valese, Sawodny Oliver, Stenzl Arnulf
Department of Urology, University Hospital Tuebingen, Tuebingen.
Institute of Applied Optics.
Curr Opin Urol. 2023 Mar 1;33(2):157-162. doi: 10.1097/MOU.0000000000001072. Epub 2022 Dec 29.
Recently, several trials as well as registry-data analyses investigating the role of robot-assisted radical cystectomy with extra or intracorporal urinary diversion were completed and follow up matured. This review aims to comment on the current evidence-based findings and interpret the future role of the robotic approach as a part of the treatment of bladder cancer.
Numerous trials and registry-data analyses revealed no significant differences in progression-free and overall survival after open radical cystectomy or robot-assisted radical cystectomy irrespective of urinary diversion. Perioperative parameters, especially intraoperative blood loss, transfusions, thromboembolic events, wound infections and hospitalization were significantly increased in open radical cystectomy. Patients' convalescence, and especially early postsurgical quality of life, was improved by the robotic approach. The highly demanding surgery itself displayed by a flat learning curve required more than 130 surgeries per institution to reach a stable plateau of complications. The performance of high-quality radical cystectomy irrespective of the approach was significantly increased in high-volume centres. Local recurrence occurs in 11% after radical cystectomy. Current research focuses on intraoperatively usable detection methods and instruments to minimize the risk of residual tumour cells.
Taken together, the total intracorporal approach in radical cystectomy holds the potential to improve perioperative parameters and reduces hospitalization without impairing oncological performance of the procedure. To provide best results for the patient radical cystectomy and especially the technically challenging total intracorporal procedure will gain importance in bladder cancer treatment but should be limited to high-volume centres.
最近，几项关于机器人辅助根治性膀胱切除术联合体外或体内尿流改道术作用的试验以及登记数据分析已经完成，随访也已成熟。本综述旨在对当前基于证据的研究结果进行评论，并解读机器人手术方法在膀胱癌治疗中的未来作用。
大量试验和登记数据分析表明，无论采用何种尿流改道术，开放根治性膀胱切除术或机器人辅助根治性膀胱切除术后的无进展生存期和总生存期均无显著差异。开放根治性膀胱切除术的围手术期参数，尤其是术中失血、输血、血栓栓塞事件、伤口感染和住院时间显著增加。机器人手术方法改善了患者的康复情况，尤其是术后早期的生活质量。这种手术难度极高，学习曲线平缓，每个机构需要进行超过130例手术才能达到并发症稳定的平台期。在高容量中心，无论采用何种手术方式，高质量根治性膀胱切除术的实施率都显著提高。根治性膀胱切除术后局部复发率为11%。目前的研究集中在术中可用的检测方法和器械，以尽量减少残留肿瘤细胞的风险。
总体而言，根治性膀胱切除术中的完全体内手术方法有可能改善围手术期参数并减少住院时间，而不影响手术的肿瘤学效果。为患者提供最佳治疗效果，根治性膀胱切除术，尤其是技术上具有挑战性的完全体内手术，在膀胱癌治疗中将变得更加重要，但应限于高容量中心。
