Rautiola Juhana, Björklund Johan, Ben-David Reuben, Skokic Viktor, Cacciamani Giovanni, Desai Mihir, Dey Linda, Mehrazin Reza, Miranda Gus, Sfakianos John, Tillu Neeraja, Wiklund Peter
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
BJU Int. 2025 Oct;136(4):747-754. doi: 10.1111/bju.16691. Epub 2025 Mar 4.
To investigate the oncological and complication outcomes in women who have undergone pelvic organ-sparing robot-assisted radical cystectomy (RARC).
We conducted a retrospective, multicentre cohort study of women with bladder cancer undergoing RARC with intracorporeal urinary diversion. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS), and secondary outcomes were 30- and 90-day high-grade complications in patients undergoing organ-sparing RARC vs non-organ-sparing RARC. Kaplan-Meier analyses, the log-rank test and Cox proportional hazard models were used to assess the associations of pelvic organ-sparing RARC with both OS and CSS. The Mann-Whitney test and chi-squared and Fisher's tests were used to compare continuous and categorical variables, respectively.
A total of 269 women underwent RARC, of whom 81 underwent pelvic organ-sparing RARC. There was no statistically significant difference between the groups in terms of clinical or pathological T stage, and the recurrence rates were similar in the two groups. There were no significant differences in CSS or OS between the groups. The two groups had similar complication profiles and rates. The incidence of high-grade (Clavien-Dindo grade ≥3a) complications was similar in the two groups: organ-sparing vs non-organ-sparing RARC: 13% vs 14% for early complications (P = 0.87) and 7% vs 6% (P = 0.70) for late complications.
Women with bladder cancer who underwent pelvic organ-sparing RARC and intracorporeal urinary diversion had similar oncological and complication outcomes compared to those who underwent non-organ-sparing RARC. Pelvic organ-sparing RARC could be considered in well selected women with bladder cancer, resulting in improved quality of life and functional outcomes.
探讨接受保留盆腔器官机器人辅助根治性膀胱切除术（RARC）的女性患者的肿瘤学及并发症结局。
我们对接受RARC及体内尿流改道的膀胱癌女性患者进行了一项回顾性多中心队列研究。主要结局为总生存期（OS）和癌症特异性生存期（CSS），次要结局为接受保留器官RARC与未保留器官RARC的患者30天和90天的高级别并发症。采用Kaplan-Meier分析、对数秩检验和Cox比例风险模型评估保留盆腔器官RARC与OS及CSS的相关性。分别采用Mann-Whitney检验、卡方检验和Fisher检验比较连续变量和分类变量。
共有269名女性接受了RARC，其中81名接受了保留盆腔器官的RARC。两组在临床或病理T分期方面无统计学显著差异，两组的复发率相似。两组在CSS或OS方面无显著差异。两组的并发症情况和发生率相似。两组高级别（Clavien-Dindo分级≥3a）并发症的发生率相似：保留器官与未保留器官的RARC：早期并发症分别为13%和14%（P = 0.87），晚期并发症分别为7%和6%（P = 0.70）。
与接受未保留器官RARC的女性相比，接受保留盆腔器官RARC及体内尿流改道的膀胱癌女性患者具有相似的肿瘤学及并发症结局。对于精心挑选的膀胱癌女性患者可考虑行保留盆腔器官RARC，从而改善生活质量和功能结局。
