학술논문
Comparing Robotic-Assisted to Open Radical Cystectomy in the Management of Non-Muscle-Invasive Bladder Cancer: A Propensity Score Matched-Pair Analysis.
Document Type
Article
Author
Courboin, Etienne; Mathieu, Romain; Panetta, Valentina; Mjaess, Georges; Diamand, Romain; Verhoest, Gregory; Roumiguié, Mathieu; Bajeot, Anne Sophie; Soria, Francesco; Lonati, Chiara; Simeone, Claudio; Simone, Giuseppe; Anceschi, Umberto; Umari, Paolo; Sridhar, Ashwin; Kelly, John; Mertens, Laura S.; Sanchez-Salas, Rafael; Colomer, Anna; Cerruto, Maria Angela
Source
Subject
*CYSTECTOMY
*RESEARCH
*SURGICAL blood loss
*STATISTICS
*LENGTH of stay in hospitals
*CONFIDENCE intervals
*SURGICAL robots
*BLOOD transfusion
*MULTIPLE regression analysis
*SURGICAL complications
*TREATMENT duration
*REGRESSION analysis
*MANN Whitney U Test
*PAIRED comparisons (Mathematics)
*NON-muscle invasive bladder cancer
*TREATMENT effectiveness
*CANCER patients
*COMPARATIVE studies
*DESCRIPTIVE statistics
*SURVIVAL analysis (Biometry)
*KAPLAN-Meier estimator
*CHI-squared test
*ODDS ratio
*DATA analysis software
*PROGRESSION-free survival
*LONGITUDINAL method
*PROPORTIONAL hazards models
*POISSON distribution
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Language
ISSN
2072-6694
Abstract
Simple Summary: In this study, we analyzed 593 patients with NMIBC who underwent radical cystectomy via a robotic-assisted or open approach between 2015 and 2020. Patients with NMIBC who underwent RARC or ORC were matched 1:1 by age, sex, BMI, year of surgery and urinary diversion. We found that RARC + ICUD for patients with NMIBC is safe and associated with a lower blood loss, a lower transfusion rate and a shorter hospital stay compared to ORC. Complication rates were similar. Concerning oncologic outcomes, RARC appeared non-inferior to ORC with no significant difference in DFS, CSS and OS. These results must be confirmed with prospective randomized studies. Background: For non-muscle-invasive bladder cancer (NMIBC) requiring radical surgery, limited data are available comparing robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) to open radical cystectomy (ORC). The objective of this study was to compare the two surgical techniques. Methods: A multicentric cohort of 593 patients with NMIBC undergoing iRARC or ORC between 2015 and 2020 was prospectively gathered. Perioperative and pathologic outcomes were compared. Results: A total of 143 patients operated on via iRARC were matched to 143 ORC patients. Operative time was longer in the iRARC group (p = 0.034). Blood loss was higher in the ORC group (p < 0.001), with a consequent increased post-operative transfusion rate in the ORC group (p = 0.003). Length of stay was longer in the ORC group (p = 0.007). Post-operative complications did not differ significantly (all p > 0.05). DFS at 60 months was 55.9% in ORC and 75.2% in iRARC with a statistically significant difference (p = 0.033) found in the univariate analysis. Conclusion: We found that iRARC for patients with NMIBC is safe, associated with a lower blood loss, a lower transfusion rate and a shorter hospital stay compared to ORC. Complication rates were similar. No significant differences in survival analyses emerged across the two techniques. [ABSTRACT FROM AUTHOR]