We compared the perioperative outcomes of open (ORC) vs. robot-assisted (RARC) radical cystectomy in the treatment of pT4a MIBC. In total, 212 patients underwent ORC (102 patients, Group A) vs. RARC (110 patients, Group B) for pT4a bladder cancer. Patients were prospectively followed and retrospectively reviewed. We assessed operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of stay, transfusion rate, and oncological outcomes. Preoperative features were comparable. The mean operative time was 232.8 vs. 189.2 min (p= 0.04), and mean EBL was 832.8 vs. 523.7 mL in Group A vs. B (p= 0.04). An intraoperative transfusion was performed in 32 (31.4%) vs. 11 (10.0%) cases during ORC vs. RARC (p= 0.03). The intraoperative complications rate was comparable. The mean length of stay was shorter after RARC (12.6 vs. 7.2 days,p= 0.02). Postoperative transfusions were performed in 36 (35.3%) vs. 13 (11.8%) cases (p= 0.03), and postoperative complications occurred in 37 (36.3%) vs. 29 (26.4%) patients in Groups A vs. B (p= 0.05). The positive surgical margin (PSM) rate was lower after RARC. No differences were recorded according to the oncological outcomes. ORC and RARC are feasible treatments for the management of pT4a bladder tumors. Minimally invasive surgery provides shorter operative time, bleeding, transfusion rate, postoperative complications, length of stay, and PSM rate.
本研究比较了开放根治性膀胱切除术（ORC）与机器人辅助根治性膀胱切除术（RARC）治疗pT4a期肌层浸润性膀胱癌的围手术期结局。共纳入212例pT4a期膀胱癌患者，其中102例接受ORC（A组），110例接受RARC（B组）。对患者进行前瞻性随访及回顾性分析。评估指标包括手术时间、估计失血量、术中及术后并发症、住院时长、输血率及肿瘤学结局。两组术前基线特征具有可比性。A组与B组平均手术时间分别为232.8分钟与189.2分钟（p=0.04），平均估计失血量分别为832.8毫升与523.7毫升（p=0.04）。术中输血率在ORC组为31.4%（32例），RARC组为10.0%（11例）（p=0.03）。两组术中并发症发生率相当。RARC组平均住院时间显著缩短（7.2天 vs 12.6天，p=0.02）。术后输血率A组为35.3%（36例），B组为11.8%（13例）（p=0.03）；术后并发症发生率A组为36.3%（37例），B组为26.4%（29例）（p=0.05）。RARC组手术切缘阳性率更低。肿瘤学结局方面两组无显著差异。结论：ORC与RARC均是治疗pT4a期膀胱肿瘤的可行方案。微创手术在缩短手术时间、减少出血量、降低输血率与术后并发症发生率、缩短住院时长及降低切缘阳性率方面具有优势。
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