Rinott Mizrahi Gal, Lawrentschuk Nathan, Thomas Benjamin, Dundee Philip
The Royal Melbourne Hospital Parkville Victoria Australia.
Epworth Hospitals Melbourne Victoria Australia.
BJUI Compass. 2024 Dec 25;6(1):e459. doi: 10.1002/bco2.459. eCollection 2025 Jan.
To evaluate the feasibility and safety of robotic-assisted salvage radical cystectomy (RA-SRC).
We retrospectively searched the prospectively collected surgical database of two highly experienced robotic urological surgeons for cases of RA-SRC, defined as RARC performed post-previous pelvic RT for palliative or oncologic treatment purposes. Collected data included demographic and clinical information and outcome measures including operative course, hospital stay and complications.
Eighteen patients were included in the current analysis. All patients had previous RT to the pelvis with 12 patients also having prior radical pelvic surgery. Indications for salvage cystectomy were either palliation ( = 12) or oncological (MIBC or high risk NMIBC, = 6). There were no intraoperative complications and no conversions to open surgery. Ninety day postoperative complications were recorded in 11 patients (61.1%), with major complications (Clavien-Dindo grades 3 and 4) in three patients (16.6%). After a median follow-up of 43.5 months, one late postoperative complication was observed requiring surgical intervention.
Our data, together with the limited published data from other cohorts of RA-SRC, suggest that in experienced hands, RA-SRC is feasible, with intraoperative and perioperative complication rates that are lower than the published data for open SRC and are equivalent to open primary RC. These data will contribute to treatment decision making both in patients with post-pelvic radiation symptoms requiring palliation and patients with MIBC considering or treated with trimodal treatment.
评估机器人辅助挽救性根治性膀胱切除术（RA-SRC）的可行性和安全性。
我们回顾性检索了两位经验丰富的机器人泌尿外科医生前瞻性收集的手术数据库中RA-SRC的病例，RA-SRC定义为在先前盆腔放疗后为姑息或肿瘤治疗目的而进行的机器人辅助根治性膀胱切除术。收集的数据包括人口统计学和临床信息以及结果指标，包括手术过程、住院时间和并发症。
本分析纳入了18例患者。所有患者均曾接受盆腔放疗，其中12例患者还曾接受过根治性盆腔手术。挽救性膀胱切除术的指征为姑息治疗（n = 12）或肿瘤治疗（肌层浸润性膀胱癌或高危非肌层浸润性膀胱癌，n = 6）。术中无并发症，无一例转为开放手术。11例患者（61.1%）记录有术后90天并发症，3例患者（16.6%）出现严重并发症（Clavien-Dindo 3级和4级）。中位随访43.5个月后，观察到1例术后晚期并发症需要手术干预。
我们的数据，连同其他RA-SRC队列的有限已发表数据表明，在经验丰富的医生手中，RA-SRC是可行的，其术中和围手术期并发症发生率低于已发表的开放手术SRC数据，且与开放原发性根治性膀胱切除术相当。这些数据将有助于为有盆腔放疗后症状需要姑息治疗的患者以及考虑或接受三联治疗的肌层浸润性膀胱癌患者的治疗决策提供参考。
