Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Department of Urology, Urology and Nephrology Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
J Laparoendosc Adv Surg Tech A. 2023 Aug;33(8):776-781. doi: 10.1089/lap.2023.0118. Epub 2023 Jun 1.
The purpose of this study was to compare the clinical outcomes of bladder cancer patients treated with extended pelvic lymph node dissection (ePLND) before or after cystectomy under robotic-assisted radical cystectomy (RARC). A retrospective study to identify 348 patients with bladder cancer who underwent RARC was performed. Of the patients, 152 (42.8%) underwent ePLND before radical cystectomy (RC) (group A) and 196 (56.3%) underwent ePLND after RC (group B). The clinical, pathological, and overall survival were compared. The total and RC operation time in Group A (total: 130.68 ± 29.25 minutes, RC: 59.45 ± 28.63 minutes) were both shorter than Group B (total: 154.17 ± 38.18 minutes, RC: 94.81 ± 41.21 minutes) ( < .05). However, no significant difference in time of ePLND. The estimate blood loss (EBL) of RC part and total operation (RC+ePLND) in group A was less than group B (both < .05), while the ePLND part did not show significance. The result of vascular and nerve injury and surgical drain withdrawal time were similar in two groups. The total number of lymph nodes in group A was fewer than group B (16 versus 26; < .05). Moreover, the number of bilateral internal iliac and presacral lymph nodes of group A was fewer than group B significantly, whereas the number of bilateral external iliac, common iliac, and obturator lymph nodes was similar in two groups. The lymph node density of group A was significantly lower than group B. The median follow-up of all patients was 33.0 months. Importantly, the survival of group B was better than group A (hazard ratio: 1.412; 95% confidence interval: 1.004-1.987; = .048). Performing ePLND before RC reveals better result on operation time and EBL, while, when ePLND after RC, the total number of lymph nodes dissected is more and the survival is better. It recommended ePLND be performed before RC, and it is necessary to recheck the internal iliac and presacral area after cystectomy.
本研究旨在比较机器人辅助根治性膀胱切除术（RARC）前行或后行扩大盆腔淋巴结清扫术（ePLND）治疗膀胱癌患者的临床结局。本研究进行了一项回顾性研究，共纳入 348 例接受 RARC 的膀胱癌患者。其中，152 例（42.8%）在根治性膀胱切除术（RC）前行 ePLND（A 组），196 例（56.3%）在 RC 后行 ePLND（B 组）。比较两组的临床、病理和总体生存情况。A 组的总手术时间和 RC 手术时间（总时间：130.68 ± 29.25 分钟，RC：59.45 ± 28.63 分钟）均短于 B 组（总时间：154.17 ± 38.18 分钟，RC：94.81 ± 41.21 分钟）（<.05）。然而，ePLND 时间无显著差异。A 组 RC 部分和总手术（RC+ePLND）的估计失血量（EBL）少于 B 组（均<.05），而 ePLND 部分则无显著差异。两组血管和神经损伤及手术引流管拔除时间的结果相似。A 组的总淋巴结数少于 B 组（16 个比 26 个；<.05）。此外，A 组双侧髂内和骶前淋巴结数量明显少于 B 组，而两组的双侧髂外、髂总及闭孔淋巴结数量相似。A 组的淋巴结密度明显低于 B 组。所有患者的中位随访时间为 33.0 个月。重要的是，B 组的生存情况优于 A 组（风险比：1.412；95%置信区间：1.004-1.987；=.048）。RC 前行 ePLND 可获得更好的手术时间和 EBL 结果，而 RC 后行 ePLND 则可切除更多的淋巴结，且生存情况更好。建议 RC 前行 ePLND，RC 后有必要对内髂和骶前区域进行再次检查。
