Robot-assisted radical cystectomy with intracorporeal urinary diversion: a Danish 11-year series.

Autor: Vrang ML; Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark., Østergren PB; Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark., Fode MM; Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark., Vangedal M; Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark., Lam GW; Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2023 Oct; Vol. 132 (4), pp. 428-434. Date of Electronic Publication: 2023 Jul 03.
DOI: 10.1111/bju.16098
Abstrakt: Objectives: To evaluate the oncological and perioperative outcomes from a large, single-centre, robot-assisted radical cystectomy (RARC) cohort performed with intracorporeal urinary diversion (ICUD).
Patients and Methods: Patients who underwent RARC because of bladder cancer or recurrent carcinoma in situ from June 2009 until August 2020 at Herlev and Gentofte Hospital were prospectively and consecutively included. Kaplan-Meier survival analysis was used to estimate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). A Cox proportional hazards model was used to identify individual predictors of outcomes. Multiple logistic regression analysis was used to identify predictors of high-grade complications (Clavien-Dindo Grade ≥III).
Results: A total of 542 patients were included. The median (interquartile range) follow-up was 5.3 (2.73-8.06) years. In all, 78 patients (14%) were converted to open surgery; 15 (3%) during cystectomy and 63 patients (12%) were converted from ICUD to extracorporeal urinary diversion. The 5-year RFS, CSS and OS rates were 63% (95% confidence interval [CI] 59%-68%), 75% (95% CI 72%-80%) and 67% (95% CI 63%-72%), respectively. Pathological non-organ-confined disease (tumour stage >T2 or positive lymph nodes) predicted poorer RFS, CSS and OS. Reconstruction with a neobladder (20% of cases) compared to an ileal conduit was the only predictor of high-grade complications (odds ratio 2.54, 95% CI 1.46-4.43; P < 0.001).
Conclusion: A RARC with ICUD is feasible as a standard surgical procedure for bladder cancer with only a few patients converted to open surgery. In our hands reconstruction with a neobladder was a strong predictor for high-grade complications.
(© 2023 BJU International.)
Databáze: MEDLINE
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