Bergengren Oskar, Belozerov Alexej, Bill-Axelson Anna, Garmo Hans, Hagberg Oskar, Aljabery Firas, Gårdmark Truls, Jahnson Staffan, Jerlström Tomas, Malmström Per-Uno, Sherif Amir, Ströck Viveka, Söderkvist Karin, Ullén Anders, Holmberg Lars, Häggström Christel, Liedberg Fredrik
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Eur J Surg Oncol. 2023 Apr;49(4):868-874. doi: 10.1016/j.ejso.2023.01.023. Epub 2023 Jan 25.
We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for urinary bladder cancer in a large population.
We included all patients without distant metastases who underwent either RARC or ORC with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days, and secondary outcomes within 90 days of surgery were reoperations, Clavien 3-5 complications, total days alive and out of hospital, and mortality. The analysis was carried out using multivariate regression models.
Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures were to a larger extent performed during later years, at high volume centers (47% vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC were more commonly readmitted (29% vs. 25%). In multivariable analysis RARC was associated with decreased risk of Clavien 3-5 complications (OR 0.58, 95% CI 0.47-0.72), reoperations (OR 0.53, 95% CI 0.39-0.71) and had more days alive and out of hospital (mean difference 3.7 days, 95% CI 2.4-5.0).
This study illustrates the "real-world" effects of a gradual and nation-wide introduction of RARC. Patients operated with RARC had fewer major complications and reoperations but were more frequently readmitted compared to ORC. The observed differences were largely due to more wound related complications among patients treated with ORC.
我们旨在比较大量人群中机器人辅助根治性膀胱切除术（RARC）和开放性根治性膀胱切除术（ORC）治疗膀胱癌后的短期结局。
我们纳入了2011年至2019年期间在瑞典膀胱癌数据库（BladderBaSe）2.0中登记的所有无远处转移且接受RARC或ORC并采用回肠导管术的患者。主要结局是90天内的非计划再入院，手术90天内的次要结局是再次手术、Clavien 3 - 5级并发症、存活并出院的总天数以及死亡率。分析采用多变量回归模型进行。
在2905例患者中，832例行RARC手术，2073例行ORC手术。机器人手术在后期、高容量中心进行的比例更高（47%对17%），更多用于器官局限性疾病（82%对72%），且在社会经济地位高的患者中更频繁进行（26%对21%）。接受RARC手术的患者更常再次入院（29%对25%）。在多变量分析中，RARC与Clavien 3 - 5级并发症风险降低相关（比值比[OR] 0.58，95%置信区间[CI] 0.47 - 0.72）、再次手术风险降低（OR 0.53，95% CI 0.39 - 0.71），并且存活并出院的天数更多（平均差异3.7天，95% CI 2.4 - 5.0）。
本研究阐述了RARC在全国范围内逐步引入的“真实世界”效应。与ORC相比，接受RARC手术的患者主要并发症和再次手术较少，但再次入院更频繁。观察到的差异主要归因于接受ORC治疗的患者中更多与伤口相关的并发症。
