Yasuda Yosuke, Numao Noboru, Fujiwara Ryo, Takemura Kosuke, Yoneoka Yusuke, Oguchi Tomohiko, Yamamoto Shinya, Yonese Junji
Department of Genitourinary Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan.
Int J Urol. 2024 Jul;31(7):724-729. doi: 10.1111/iju.15447. Epub 2024 Mar 13.
The objective of the study was to describe the surgical outcome of robot-assisted radical cystectomy and predictive factors for major complications in real-world clinical practice at a single institution in Japan.
We retrospectively analyzed 208 consecutive patients undergoing robot-assisted radical cystectomy at our institution between 2019 and 2023. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed. Postoperative complications were defined as minor complications (Clavien-Dindo grades 1-2) or major complications (grades 3-5). Predictors of complications were examined using multivariable logistic analysis.
Overall, 147 men and 61 women, median age 70 years (interquartile range, 62-77), were included in this study. Median operative time and estimated blood loss were 8.4 h and 185 mL, respectively; 11 patients (5%) received intraoperative blood transfusions. For urinary diversions, ileal conduit, neobladder, and cutaneous ureterostomy were performed in 153 (74%), 49 (24%), and 6 (3%) patients, respectively. Urinary diversions were primarily performed with extracorporeal urinary diversion. In total, 140 complications occurred in 111 patients (53%) within 30 days. Of these patients, 31 major complications occurred in 28 patients, and one perioperative death (0.5%) with a postoperative cardiovascular event. Multivariable analysis showed only prolonged operative time (odds ratio: 4.34, 95% confidence interval: 1.82-10.35, p < 0.01) was the independent risk factor for major complications.
This study reports surgical outcomes at our single institution. Prolonged operative time was a significant prognostic factor for major complications. As far as we know, this study reports the largest number of robot-assisted radical cystectomy cases at a single center in Japan.
本研究的目的是描述在日本一家机构的实际临床实践中，机器人辅助根治性膀胱切除术的手术结果以及主要并发症的预测因素。
我们回顾性分析了2019年至2023年期间在本机构连续接受机器人辅助根治性膀胱切除术的208例患者。回顾了患者和疾病特征、术中细节以及围手术期结果。术后并发症分为轻微并发症（Clavien-Dindo 1-2级）或严重并发症（3-5级）。使用多变量逻辑分析检查并发症的预测因素。
本研究共纳入147例男性和61例女性，中位年龄70岁（四分位间距，62-77岁）。中位手术时间和估计失血量分别为8.4小时和185毫升；11例患者（5%）接受了术中输血。对于尿流改道，分别有153例（74%）、49例（24%）和6例（3%）患者进行了回肠膀胱术、新膀胱术和皮肤输尿管造口术。尿流改道主要采用体外尿流改道。共有111例患者（53%）在30天内发生了140例并发症。其中，28例患者发生了31例严重并发症，1例围手术期死亡（0.5%），死于术后心血管事件。多变量分析显示，只有手术时间延长（比值比：4.34，95%置信区间：1.82-10.35，p<0.01）是严重并发症的独立危险因素。
本研究报告了我们单一机构的手术结果。手术时间延长是严重并发症的一个重要预后因素。据我们所知，本研究报告了日本单一中心机器人辅助根治性膀胱切除术病例数最多的情况。
