Chen Hao, Li Kaiwen, Lin Tianxin, Huang Jian
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Ann Surg Oncol. 2025 Jun 20. doi: 10.1245/s10434-025-17617-x.
Robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) are becoming increasingly prevalent. However, whether the two surgical procedures share the same oncologic outcomes remains controversial.
A multicenter, retrospective study was conducted. Patients who underwent radical cystectomy for histologically confirmed bladder cancer at ten centers between 2012 and 2019 were enrolled. Data on baseline conditions, perioperative details, pathological results, and survival outcomes were collected. The primary outcome measures were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Propensity score matching was conducted to reduce the effects of bias and confounding variables, while multiple imputation was applied to address missing variables.
A total of 2766 patients were enrolled, including 1291 LRC patients and 1475 RARC patients. After propensity score matching, a total of 753 pairs of patients were obtained. In the RARC group, organ-confined diseases were detected in 482 patients (64.0%). Lymph node metastasis was observed in 120 (15.9%) patients. In the LRC group, organ-confined diseases were detected in 521 (69.2%) patients, and 101 (13.4%) patients had lymph node metastasis. The median follow-up time was 47.6 months (33.4-63.4 months) for the RARC group and 45.6 months (23.1-70.8 months) for the LRC group. Survival analysis showed no statistically significant differences in OS (HR: 0.89, 95% CI: 0.72-1.10, p = 0.269), RFS (HR: 0.84, 95% CI: 0.69-1.01, p = 0.069), and CSS (HR: 0.86, 95% CI: 0.68-1.08, p = 0.196) between the two groups. Recurrent bladder cancer, T stage, and lymph node metastasis were identified as significant risk factors.
There were no statistically significant differences in oncologic outcomes between RARC and LRC.
机器人辅助根治性膀胱切除术（RARC）和腹腔镜根治性膀胱切除术（LRC）正变得越来越普遍。然而，这两种手术方式是否具有相同的肿瘤学预后仍存在争议。
进行了一项多中心回顾性研究。纳入了2012年至2019年间在十个中心因组织学确诊膀胱癌而接受根治性膀胱切除术的患者。收集了关于基线情况、围手术期细节、病理结果和生存结局的数据。主要结局指标为总生存期（OS）、无复发生存期（RFS）和癌症特异性生存期（CSS）。进行倾向评分匹配以减少偏倚和混杂变量的影响，同时应用多重填补法处理缺失变量。
共纳入2766例患者，其中LRC患者1291例，RARC患者1475例。经过倾向评分匹配后，共获得753对患者。在RARC组中，482例患者（64.0%）检测到器官局限性疾病。120例（15.9%）患者观察到淋巴结转移。在LRC组中，521例（69.2%）患者检测到器官局限性疾病，101例（13.4%）患者有淋巴结转移。RARC组的中位随访时间为47.6个月（33.4 - 63.4个月），LRC组为45.6个月（23.1 - 70.8个月）。生存分析显示，两组在OS（风险比：0.89，95%置信区间：0.72 - 1.10，p = 0.269）、RFS（风险比：0.84，95%置信区间：0.69 - 1.01，p = 0.069）和CSS（风险比：0.86，95%置信区间：0.68 - 1.08，p = 0.196）方面无统计学显著差异。复发性膀胱癌、T分期和淋巴结转移被确定为显著风险因素。
RARC和LRC在肿瘤学预后方面无统计学显著差异。
