Suartz Caio Vinícius, Martinez Lucas Motta, Brito Pedro Henrique, Neto Carlos Victori, Cordeiro Maurício Dener, Botelho Luiz Antonio Assan, Gallucci Fábio Pescarmona, Mota José Maurício, Nahas William Carlos, Ribeiro-Filho Leopoldo Alves
Urology Department, Hôpital Européen Georges Pompidou, AP-HP. Centre Université Paris Cité Paris France.
Division of Urology, Institute of Cancer of São Paulo University of São Paulo São Paulo Brazil.
BJUI Compass. 2024 Feb 1;5(3):327-333. doi: 10.1002/bco2.333. eCollection 2024 Mar.
Surgical intervention is the treatment of choice in patients with urachal carcinoma. Due to complications and to reduce hospital stay from open surgery, minimally invasive approaches are desirable. Nowadays, robotic-assisted surgery has become increasingly popular, and robot-assisted cystectomy can be performed in patients with urachal carcinoma with low complication rates.
We performed a systematic review to search for studies that evaluated patients who underwent robotic-assisted surgery for urachal carcinoma. The outcomes of interest were the type of cystectomy performed, whether there was umbilicus resection, total operative time, console time, intraoperative complications, estimated blood loss, postoperative complications, time of hospitalisation, positive surgical margins and the presence of documented tumour recurrence.
In this study, we evaluated three cohorts comprising a total of 21 patients. The median follow-up period ranged from 8 to 40 months. Medium age was between 51 and 54 years, with a majority (63.1%) being male. One patient (5.2%) underwent a radical cystectomy, and 19 patients (94.7%) underwent to partial cystectomy. Umbilical resections were performed in all cases, and pelvic lymphadenectomy in 14 cases (73.6%). Recurrence occurred in three patients at a median of 17 months postoperation, two cases in the trocar insertion site. Additionally, there was one death, which was attributed to postoperative cardiovascular complications.
Robotic-assisted partial cystectomy has a low incidence of adverse outcomes in patients with urachal carcinoma. Controlled studies, ideally randomised, are warranted to establish the comparative efficacy and safety of the robotic-assisted cystectomy approach relative to open surgery.
手术干预是脐尿管癌患者的首选治疗方法。由于开放手术存在并发症且会延长住院时间，因此微创方法更为可取。如今，机器人辅助手术越来越受欢迎，机器人辅助膀胱切除术可用于脐尿管癌患者，且并发症发生率较低。
我们进行了一项系统评价，以寻找评估接受机器人辅助脐尿管癌手术患者的研究。感兴趣的结果包括所施行的膀胱切除术类型、是否进行脐部切除、总手术时间、控制台操作时间、术中并发症、估计失血量、术后并发症、住院时间、手术切缘阳性情况以及记录在案的肿瘤复发情况。
在本研究中，我们评估了三个队列，共21例患者。中位随访期为8至40个月。中位年龄在51至54岁之间，大多数（63.1%）为男性。1例患者（5.2%）接受了根治性膀胱切除术，19例患者（94.7%）接受了部分膀胱切除术。所有病例均进行了脐部切除，14例（73.6%）进行了盆腔淋巴结清扫术。3例患者出现复发，中位复发时间为术后17个月，2例发生在套管针穿刺部位。此外，有1例死亡，归因于术后心血管并发症。
机器人辅助部分膀胱切除术在脐尿管癌患者中的不良结局发生率较低。有必要开展对照研究，最好是随机对照研究，以确定机器人辅助膀胱切除术相对于开放手术的比较疗效和安全性。
