Inoue Takahiro, Kato Manabu, Sasaki Takeshi, Sugino Yusuke, Owa Shunsuke, Nishikawa Taketomo, Kato Momoko, Higashi Shinichiro, Masui Satoru, Nishikawa Kouhei
Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan.
Transl Cancer Res. 2024 Jan 31;13(1):46-56. doi: 10.21037/tcr-23-1234. Epub 2024 Jan 15.
Robot-assisted radical cystectomy (RARC) with urinary diversion has become a standard surgical procedure because of its three-dimensional high-definition surgical field of view, flexibility, and stability. However, because of the highly complex steps of surgery, postoperative complications cannot be ignored.
This retrospective, single-center, observational cohort study investigated the postoperative complications following RARC at a non-high-volume center in Japan. From August 2019 to March 2023, 50 consecutive patients who underwent RARC for histologically proven muscle-invasive bladder cancer (MIBC) or high-risk non-MIBC with an indication for radical cystectomy according to the Japanese Urological Association Guideline 2019 were included. Factors correlated with the selection of extracorporeal urinary diversion (ECUD) or cutaneous ureterostomy rather than intracorporeal urinary diversion (ICUD) for urinary diversion were also investigated.
In total, 33 (66%) and 31 (62%) patients experienced complications during the first 90 and 30 days after RARC, respectively. Among them, 19 (38%) and 18 (36%) patients developed Clavien-Dindo classification G2 complications, and 12 (24%) and 11 (22%) developed G3 or higher (major) complications during the first 90 and 30 days after RARC, respectively. The most common complications were gastrointestinal complications (26%) and urinary tract infections (22%). Nine patients (18%) underwent surgical intervention within 90 days of undergoing RARC. Higher infusion volume during the operations was significantly correlated with the occurrence of major complications within 90 days (P=0.025) and 30 days (P=0.0158) after RARC. Nineteen patients (38%) underwent non-ICUD. Twelve patients received ECUD as an ileal conduit or neobladder, and among them, three patients received ECUD due to intraabdominal adhesion for previous abdominal surgery or radiation, while four patients received ECUD ileal conduit due to comorbidities and advanced cases (palliative surgery) to shorten the surgery time.
Surgical complications related to the initial experience with RARC at a non-high-volume center in Japan cannot be ignored. Although this complicated surgical procedure requires a learning curve to achieve a stable rate of much fewer major complications after RARC, careful assessment of patients' status before surgery and critical postoperative management may reduce complication rates more quickly, even at non-high-volume centers.
机器人辅助根治性膀胱切除术（RARC）并尿流改道因其三维高清手术视野、灵活性和稳定性，已成为一种标准的外科手术。然而，由于手术步骤高度复杂，术后并发症不容忽视。
这项回顾性、单中心观察性队列研究调查了日本一家非高手术量中心RARC术后的并发症。纳入2019年8月至2023年3月期间连续50例根据日本泌尿外科学会2019年指南因组织学证实的肌层浸润性膀胱癌（MIBC）或有根治性膀胱切除术指征的高危非MIBC接受RARC的患者。还调查了与选择体外尿流改道（ECUD）或皮肤输尿管造口术而非体内尿流改道（ICUD）进行尿流改道相关的因素。
总共33例（66%）和31例（62%）患者分别在RARC后的前90天和30天内出现并发症。其中，19例（38%）和18例（36%）患者发生Clavien-Dindo分类G2级并发症，12例（24%）和11例（22%）患者分别在RARC后的前90天和30天内发生G3级或更高级别（严重）并发症。最常见的并发症是胃肠道并发症（26%）和尿路感染（22%）。9例（18%）患者在接受RARC后90天内接受了手术干预。手术期间较高的输液量与RARC后90天内（P = 0.025）和30天内（P = 0.0158）严重并发症的发生显著相关。19例（38%）患者接受了非ICUD。12例患者接受ECUD作为回肠膀胱术或新膀胱术，其中3例患者因既往腹部手术或放疗导致腹腔粘连而接受ECUD，4例患者因合并症和晚期病例（姑息性手术）接受ECUD回肠膀胱术以缩短手术时间。
在日本一家非高手术量中心，与RARC初期经验相关的手术并发症不容忽视。尽管这种复杂的外科手术需要一个学习曲线来实现RARC后严重并发症发生率稳定在低得多的水平，但即使在非高手术量中心，术前仔细评估患者状况和关键的术后管理可能会更快降低并发症发生率。
