机器人辅助与开放性根治性膀胱切除术：住院不良结局比较

Robot-Assisted Versus Open Radical Cystectomy: Comparison of Adverse In-Hospital Outcomes.

作者信息

Di Bello Francesco, Rodriguez Peñaranda Natali, Marmiroli Andrea, Longoni Mattia, Falkenbach Fabian, Chi Le Quynh, Tian Zhe, Goyal Jordan A, Collà Ruvolo Claudia, Califano Gianluigi, Creta Massimiliano, Saad Fred, Shariat Shahrokh F, Puliatti Stefano, De Cobelli Ottavio, Briganti Alberto, Graefen Markus, Chun Felix H K, Longo Nicola, Karakiewicz Pierre I

机构信息

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.

出版信息

J Surg Oncol. 2025 Mar 28. doi: 10.1002/jso.28108.

DOI:10.1002/jso.28108

PMID:40152714

Abstract

PURPOSE

To quantify improvements in adverse in-hospital outcomes between historical and contemporary robot-assisted radical cystectomy (RARC) versus historical and contemporary open RC (ORC).

MATERIAL AND METHODS

Within the National Inpatient Sample (2010-2019), RARC and ORC ileal conduit diversion patients were identified. Multivariable logistic and Poisson regression models were fitted.

RESULTS

Of RARC patients, 1343 (39%) were historical (2010-2014) and 2087 (61%) were contemporary (2015-2019). Of ORC patients, 5812 (54%) were historical and 5019 (46%) were contemporary. Versus historical counterparts, contemporary RARC patients exhibited significantly better adverse in-hospital outcomes in 9 of 13 categories, with improvements ranging from -82% for intraoperative complications to -22% for cumulative postoperative complications. Similarly, versus historical, contemporary ORC patients also exhibited significantly better adverse in-hospital outcomes in 9 of 13 categories, with improvements ranging from -72% for intraoperative complications to -12% for median length of stay (LOS). When contemporary RARC was compared to contemporary ORC, RARC adverse in-hospital outcomes were better in 7 of 13 comparisons, with improvements ranging from -55% for blood transfusions to -18% for median LOS. Similarly, when historical RARC was compared to historical ORC, RARC adverse in-hospital outcomes were better in 6 of 13 comparisons, with improvements ranging from -55% for blood transfusions to -15% for median LOS.

CONCLUSION

The magnitude of the improvement in adverse in-hospital outcomes was comparable between contemporary versus historical RARC (nine improved categories) and contemporary versus historical ORC (nine improved categories). However, contemporary RARC outperformed contemporary ORC in 7 of 13 categories of adverse in-hospital outcomes.

摘要

目的

量化历史时期与当代机器人辅助根治性膀胱切除术（RARC）以及历史时期与当代开放性根治性膀胱切除术（ORC）之间住院不良结局的改善情况。

材料与方法

在国家住院患者样本（2010 - 2019年）中，确定了RARC和ORC回肠导管改道患者。拟合多变量逻辑回归和泊松回归模型。

结果

在RARC患者中，1343例（39%）为历史时期（2010 - 2014年），2087例（61%）为当代（2015 - 2019年）。在ORC患者中，5812例（54%）为历史时期，5019例（46%）为当代。与历史时期的同行相比，当代RARC患者在13个类别中的9个类别中表现出明显更好的住院不良结局，改善幅度从术中并发症的 - 82%到术后累积并发症的 - 22%不等。同样，与历史时期相比，当代ORC患者在13个类别中的9个类别中也表现出明显更好的住院不良结局，改善幅度从术中并发症的 - 72%到中位住院时间（LOS）的 - 12%不等。当将当代RARC与当代ORC进行比较时，在13项比较中的7项中，RARC的住院不良结局更好，改善幅度从输血的 - 55%到中位LOS的 - 18%不等。同样，当将历史时期的RARC与历史时期的ORC进行比较时，在13项比较中的6项中，RARC的住院不良结局更好，改善幅度从输血的 - 55%到中位LOS的 - 15%不等。