학술논문
Assessing Trifecta and Pentafecta Success Rates between Robot-Assisted vs. Open Radical Cystectomy: A Propensity Score-Matched Analysis.
Document Type
Article
Author
Gavi, Filippo; Foschi, Nazario; Fettucciari, Daniele; Russo, Pierluigi; Giannarelli, Diana; Ragonese, Mauro; Gandi, Carlo; Balocchi, Giovanni; Francocci, Alessandra; Bizzarri, Francesco Pio; Marino, Filippo; Filomena, Giovanni Battista; Palermo, Giuseppe; Totaro, Angelo; Racioppi, Marco; Bientinesi, Riccardo; Sacco, Emilio
Source
Subject
*CYSTECTOMY
*SURGICAL robots
*PROBABILITY theory
*BLOOD loss estimation
*TREATMENT effectiveness
*RETROSPECTIVE studies
*SURGICAL blood loss
*CANCER patients
*MANN Whitney U Test
*CHI-squared test
*SURGICAL margin
*MEDICAL records
*ACQUISITION of data
*COMPARATIVE studies
*BLOOD transfusion
*OVERALL survival
*PERIOPERATIVE care
*EVALUATION
BLADDER tumors
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Language
ISSN
2072-6694
Abstract
Simple Summary: The use of robot-assisted radical cystectomy (RARC) is increasing, although its definitive superiority over open radical cystectomy (ORC) has not been proven. Randomized controlled trials (RCTs) have demonstrated RARC's superiority regarding perioperative and functional outcomes but not in terms of oncologic and survival outcomes. Composite outcomes, such as the trifecta and pentafecta, have been proposed to evaluate the quality of the surgery. The aim of our retrospective study was to assess the superiority of RARC over ORC using the PROMETRIC group's trifecta and pentafecta criteria in a propensity score-matched analysis to reduce biases. No differences were found in the success rates of trifecta and pentafecta. The overall survival was comparable between the two cohorts. We confirmed the superiority of RARC in significantly reducing the estimated blood loss and perioperative transfusion rates. Background: This study aimed to evaluate the surgical and oncological outcomes of robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) using trifecta and pentafecta parameters. Methods: The clinical data of 41 patients who underwent RARC between 2018 and 2022 were prospectively collected and retrospectively compared to those of 330 patients undergoing ORC using 1:1 propensity score matching. Trifecta was defined as simultaneous negative surgical margins (SMs), a lymph node (LN) yield ≥ 16, and the absence of major complications (Clavien–Dindo grade III–V) within 90 days postoperatively. Pentafecta additionally included a 12-month recurrence-free rate and a time between the transurethral resection of a bladder tumor (TURBT) and radical cystectomy (RC) ≤ 3 months. The continuous variables were compared using the Mann–Whitney U test, and the categorical variables were analyzed using the chi-squared test. Results: No statistically significant differences in trifecta and pentafecta success rates were observed between the RARC and ORC cohorts after propensity score matching. However, the RARC group exhibited significantly reduced blood loss (RARC: 317 mL vs. ORC: 525 mL, p = 0.01). Conclusions: RARC offers distinct advantages over ORC in terms of reduced blood loss, while trifecta and pentafecta success rates do not differ significantly between the two surgical approaches. [ABSTRACT FROM AUTHOR]