Introduction:This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy.Methods:The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan–Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors.Results:A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients’ characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (allp< 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (bothp< 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09–0.72;p= 0.02) but not the need for re-intervention. A Kaplan–Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14–0.94;p= 0.04).Conclusions:Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery.
引言：本研究比较了机器人辅助与开放式根治性膀胱切除术联合皮肤输尿管造口术治疗预期寿命有限的虚弱膀胱癌患者的手术及生存结局。 方法：检索2016年6月1日至2022年8月31日期间机构数据库中采用皮肤输尿管造口术的膀胱切除病例。根据手术方式将研究人群分为两组，比较基线特征与手术结局。通过逻辑回归分析确定大出血事件（血红蛋白下降≥3.5 g/dL或需输血）及术后30天内再次手术的预测因素。采用Kaplan-Meier法评估机器人手术对总生存期的影响，并通过Cox回归分析其预测因子。 结果：共纳入145例患者，其中30%（43例）接受机器人膀胱切除术。两组患者特征及肿瘤分期分布具有可比性，但微创治疗组患者的排气时间、肠道功能恢复时间及住院时间均显著缩短（均p<0.001）。尽管该组手术时间较长，但大出血事件（60% vs. 89%）和术后严重并发症发生率（0 vs. 8%）均显著低于开放手术组（均p<0.001）。逻辑回归显示机器人手术是大出血事件的独立保护因素（OR: 0.26; 95%CI 0.09–0.72; p=0.02），但与再次手术需求无显著关联。Kaplan-Meier分析表明机器人膀胱切除术在总生存期方面具有显著优势（LogRank=0.03），Cox回归分析进一步验证了这一结果（HR: 0.39; 95%CI 0.14–0.94; p=0.04）。 结论：对于虚弱膀胱癌患者，机器人膀胱切除术联合皮肤输尿管造口术是一种可行的治疗选择。与开放手术相比，微创术式可降低出血及严重并发症风险，促进肠道功能快速恢复，并缩短住院时间。
肿瘤(癌症)患者之家