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Li P, Meng C, Peng L, Gan L, Xie Y, Liu Y, Li Y. Perioperative comparison between robot-assisted and laparoscopic radical cystectomy: An update meta-analysis. Asian J Surg 2023; 46:3464-3479. [PMID: 37188592 DOI: 10.1016/j.asjsur.2023.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/01/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
We conducted this study to explore the efficacy and safety of laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BC).We searched the PubMed, Embase, Cochrane Library and Web of Science databases for studies on LRC and RARC treatment of BC from the time of the databases creation to May 1, 2022. We extracted data and used Stata 16.0 for calculation and statistical analyses.Thirteen studies with 1509 patients were included. Meta-analysis showed no statistically significant differences (P > 0.05) between RARC and LRC in terms of operative time (weighted mean difference [WMD] = 14.48; 95% confidence interval [CI][-2.49, 31.44], P = 0.001), estimated intraoperative blood loss (WMD = -4.23; 95% CI [-81.48, 73.01], P = 0.001), intraoperative blood transfusion (odds ratio [OR] = 0.7; 95% CI [0.39, 1.27]; P = 0.011), positive surgical margins (OR = 1.21; 95% CI [0.61, 2.03]; P = 0.855), time to regular diet, length of hospital stay (WMD = 0.37, 95% CI [-1.73, 2.46]; P = 0.001), postoperative hospital days (WMD = -0.52; 95% CI [-1.15, 0.11], P = 0.359), intraoperative complications, 30- day postoperative complications, and 90- day postoperative complications. However the RARC lymph node yield was higher than that of LRC (WMD = 1.87; 95% CI [0.74, 2.99], P = 0.147).Our study showed that LRC and RARC have similar efficacy and safety profiles for the treatment of muscle invasive bladder cancer.
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Affiliation(s)
- Pan Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China; Department of Urology, The People's Hospital of Pengan County, Pengan, 637800, Nanchong, Sichuan, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, 730000, China
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Ye Xie
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Yi Liu
- Department of Urology, The People's Hospital of Pengan County, Pengan, 637800, Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China.
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Long J, Wang L, Dong N, Bai X, Chen S, Sun S, Liang H, Lin Y. Robotic-assisted versus standard laparoscopic radical cystectomy in bladder cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:1024739. [PMID: 36439450 PMCID: PMC9681903 DOI: 10.3389/fonc.2022.1024739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the efficacy and safety of robotic-assisted radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) in the treatment of bladder cancer. Methods Two researchers independently searched PubMed, Embase, Cochrane, and CBM using the index words to identify the qualified studies which included randomized controlled trials (RCTs) and non-randomized controlled trials (prospective and retrospective studies), and the investigators scanned references of these articles to prevent missing articles. Differences in clinical outcomes between the two procedures were analyzed by calculating odds risk (OR) and mean difference (MD) with an associated 95% confidence interval (CI). Results Sixteen comparative studies were included in the meta-analysis with 1467 patients in the RARC group and 897 patients in the LRC group. The results indicated that RARC could significantly decrease blood loss (P = 0.01; MD: -82.56, 95% CI: -145.04 to -20.08), and complications 90 days or more after surgery, regardless of whether patients were Grade ≤ II (P = 0.0008; OR: 0.63, 95% CI: 0.48 to 0.82) or Grade ≥ III (P = 0.006; OR: 0.59, 95% CI: 0.40 to 0.86), as well as overall complications (P: 0.01; OR = 0.52; 95% CI: 0.32 to 0.85). However, there was no statistical difference between the two groups at total operative time, intraoperative complications, transfusion rate, short-term recovery, hospital stay, complications within 30 days of surgery, and bladder cancer-related mortality. Conclusions The meta-analysis demonstrates that RARC is a safe and effective treatment for bladder cancer, like LRC, and patients with RARC benefit from less blood loss and fewer long-term complications related to surgery, and should be considered a viable alternative to LRC. There still need high-quality, larger sample, multi-centric, long-term follow-up RCTs to confirm our conclusion.
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Affiliation(s)
- Junhao Long
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ni Dong
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Bai
- Department of Anesthesiology, Eye Hospital of Hebei Province, Xingtai, China
| | - Siyu Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shujun Sun
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Shujun Sun, ; Yun Lin,
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Lin
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Shujun Sun, ; Yun Lin,
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Tuo Z, Zhang Y, Wang J, Zhou H, Lu Y, Wang X, Yang C, Yu D, Bi L. Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study. BMC Urol 2021; 21:159. [PMID: 34781963 PMCID: PMC8591944 DOI: 10.1186/s12894-021-00920-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of the three-port approach and conventional five-port laparoscopic radical cystectomy (LRC) with an ileal conduit. METHODS Eighty-four patients, who were diagnosed with high-risk non-muscle-invasive and muscle-invasive bladder carcinoma and underwent LRC with an ileal conduit between January 2018 and April 2020, were retrospectively evaluated. Thirty and fifty-four patients respectively underwent the three-port approach and five-port LRC. Clinical characteristics, pathological data, perioperative outcomes, and follow-up data were analysed. RESULTS There were no differences in perioperatively surgical outcome, including pathology type, prostate adenocarcinoma incidence, tumour staging, and postoperative creatinine levels between the two groups. The operative time (271.3 ± 24.03 vs. 279.57 ± 48.47 min, P = 0.299), estimated blood loss (65 vs. 90 mL, P = 0.352), time to passage of flatus (8 vs. 10 days, P = 0.084), and duration of hospitalisation post-surgery (11 vs. 12 days, P = 0.922) were no clear difference between both groups. Compared with the five-port group, the three-port LRC group was related to lower inpatient costs (12 453 vs. 14 134 $, P = 0.021). Our follow-up results indicated that the rate of postoperative complications, 90-day mortality, and the oncological outcome did not show meaningful differences between these two groups. CONCLUSIONS Three-port LRC with an ileal conduit is technically safe and feasible for the treatment of bladder cancer. On comparing the three-port LRC with the five-port LRC, our technique does not increase the rate of short-term and long-term complications and tumour recurrence, but the treatment costs of the former were reduced.
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Affiliation(s)
- Zhouting Tuo
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Ying Zhang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Jinyou Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Huan Zhou
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Youlu Lu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Xin Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Chao Yang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Dexin Yu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China
| | - Liangkuan Bi
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, NO. 678 Furong Road, Hefei, 230032, China.
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Dong L, Qin Y, Ya L, Liang C, Tinghui H, Pinlin H, Jin Y, Youliang W, Shu C, Tao W. Bayesian network analysis of open, laparoscopic, and robot-assisted radical cystectomy for bladder cancer. Medicine (Baltimore) 2020; 99:e23645. [PMID: 33350743 PMCID: PMC7769378 DOI: 10.1097/md.0000000000023645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We have performed the direct and network meta-analysis to evaluate the safety and efficacy of robot-assisted (RARC) versus laparoscopic (LRC) versus open radical cystectomy (ORC) for bladder cancer (BCa). METHODS A systematic search of PubMed, Cochrane Library, and Embase was performed up until Dec 20, 2019. Outcome indexes include oncologic outcomes (the recurrence rate, mortality), pathologic outcomes (lymph node yield (LNY), positive lymph node (PLN), positive surgical margins (PSM)), perioperative outcomes (operating time (OP), estimated blood loss (EBL), blood transfusion rate, the length of hospital stay (LOS) and the time to regular diet) and postoperative 90-day complications. RESULTS We have analyzed 6 RCTs, 23 prospective studies, and 25 retrospective studies (54 articles: 6382 patients). On one hand, the direct meta-analysis shows RARC is better than LRC or ORC. On the other hand, the clinical effects of the recurrence rate, Morbidity, PSM, LNY, PLN, and postoperative 90-day complications of RARC, LRC and ORC are all no statistical significance by network meta-analysis. Moreover, the probability rank shows that the comprehensive rank of RARC is better than LRC or ORC. The clinical effects of OP, EBL, LOS, blood transfusion rate and the time to regular diet are all statistical significance by network meta-analysis. There are ORC > LRC > RARC in the EBL ranking. Patients with RARC exhibited a decrease of LOS compared to those with LRC or ORC. Patients with RARC exhibited a decrease in blood transfusion rate and the time to regular diet compared to those with ORC. Patients with ORC exhibited an increase of OP compared to those with RARC or LRC. The heterogeneity tests of most studies are < 50%. Most studies have no publication bias and the quality of the selected studies is good. CONCLUSION The direct meta-analysis and network meta-analysis suggest that RARC is better than LRC or ORC according to comprehensive analysis. However, we need a large sample size and more high-quality studies to verify and improve in the further.
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Affiliation(s)
- Lin Dong
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Yu Qin
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu
| | - Lu Ya
- Department of Respiratory, Affiliated Hospital of Chengdu Medical College
| | - Cao Liang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Hu Tinghui
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - He Pinlin
- Department of Urology, Affiliated Hospital of Chengdu University
| | - Yang Jin
- Department of Urology, Affiliated Hospital of Chengdu University
| | - Wang Youliang
- Department of Laboratory, Pengzhou People's Hospital, Chengdu, Sichuan, China
| | - Cui Shu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Wu Tao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
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Arora A, Pugliesi F, Zugail AS, Moschini M, Pazeto C, Macek P, Stabile A, Lanz C, Mombet A, Bennamoun M, Sanchez-Salas R, Cathelineau X. Comparing Perioperative Complications Between Laparoscopic and Robotic Radical Cystectomy for Bladder Cancer. J Endourol 2020; 34:1033-1040. [DOI: 10.1089/end.2020.0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amandeep Arora
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Felipe Pugliesi
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Ahmed S. Zugail
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marco Moschini
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Cristiano Pazeto
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Armando Stabile
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Mostefa Bennamoun
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
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Feng D, Li A, Hu X, Lin T, Tang Y, Han P. Comparative effectiveness of open, laparoscopic and robot-assisted radical cystectomy for bladder cancer: a systematic review and network meta-analysis. MINERVA UROL NEFROL 2020; 72:251-264. [DOI: 10.23736/s0393-2249.20.03680-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Thomsen FB, Pedersen TB, Berg KD, Clark PE, Lund L. Comparison of venous thromboembolic complications following urological surgery between patients with or without cancer. Turk J Urol 2020; 46:tud.2020.20030. [PMID: 32412407 PMCID: PMC7360159 DOI: 10.5152/tud.2020.20030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Guidelines recommend 4 weeks of thromboembolic prophylaxis in patients who undergo major surgery for solid malignancies. However, there are limited head-to-head comparisons of risk of venous thromboembolic complications in patients with and without cancer undergoing similar surgical procedures. The purpose of this study was to compare risk of venous thromboembolic complications following major renal surgery and cystectomy between patients with and without cancer at the time of surgery. MATERIAL AND METHODS In the nationwide Danish National Patient Registry, which captures all hospital contacts, including surgical procedures, we identified 8,645 patients who underwent major renal surgery (4,273 without cancer and 4,372 with cancer) and 2,164 patients who underwent cystectomy (359 without cancer and 1,805 with cancer) in 2000-2009. The rate of venous thromboembolic events within 6 months from surgery was compared for patients with and without cancer after stratification on organ using Chi-squared test. RESULTS There was no difference in the rate of venous thromboembolic complications within the first 6 months after major renal surgery (0.4% and 0.3% [p=0.91]) or cystectomy (1.3% and 0.8% [p=0.44]) for patients with and without cancer. The cost for 28 days of Tinzaparin 4.500 IE administered by the patient was €112, whereas the cost if administered by a community nurse was €1.988. CONCLUSIONS Our study questions the different recommendations in thromboembolic prophylaxis between patients with and without cancer after major renal surgery and cystectomy.
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Affiliation(s)
- Frederik B. Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | | | - Kasper D. Berg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen, Denmark
- Department of Urology, Holstebro Hospital, Holstebro, Denmark
| | - Peter E. Clark
- Department of Urology, Carolinas HealthCare System, Levine Cancer Institute, North Carolina, NC, USA
- Department of Clinical Research Urology, University of Southern Denmark, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research Urology, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
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Peng L, Li J, Cao D, Ren Z, Wei T, You C, Cheng B, Wei Q, Li Y. Can robotic-assisted radical cystectomy provide patients with a smaller trauma and faster recovery period? A systematic review and meta-analysis of comparative trials. J Cancer Res Clin Oncol 2020; 146:1591-1601. [PMID: 32185487 DOI: 10.1007/s00432-020-03183-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/11/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This article explores the differences in the effectiveness and safety of the treatment of bladder cancer (BC) by robotic-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC). METHODS A systematic search was performed using databases including Medline, PubMed and Web of Science within a limited period from January 1, 2000, to September 1, 2019. RevMan 5.3 was used for calculation and statistical analyses. RESULTS We performed meta-analysis on operation time, estimated blood loss, intraoperative blood transfusion, positive surgical margin, oral intake time, length of hospital stay, complication and other indicators, and found that there were no statistically significant differences between LRC and RARC. CONCLUSION Our meta-analysis results show that LRC and RARC have similar results on the effectiveness and safety of BC. For those medical institutions that cannot perform robot-assisted surgery but are seeking minimally invasive and faster postoperative recovery, LRC is worth considering. However, a larger sample size, more rigorous design and longer follow-up randomized controlled trials are still needed to support our conclusions.
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Affiliation(s)
- Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- State Key Laboratory of Biotherapy and Cancer Center, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhengju Ren
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- State Key Laboratory of Biotherapy and Cancer Center, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Tangqiang Wei
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Chengyu You
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Bo Cheng
- Department of Neurology, The Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China.
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Comparison of perioperative and oncologic outcomes between robot-assisted and laparoscopic radical cystectomy for bladder cancer: a systematic review and updated meta-analysis. Int Urol Nephrol 2020; 52:1243-1254. [DOI: 10.1007/s11255-020-02406-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/03/2020] [Indexed: 12/24/2022]
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Su S, Gu L, Ma X, Li H, Wang B, Shi T, Zhang X. Comparison of Laparoscopic and Robot-assisted Radical Cystectomy for Bladder Cancer: Perioperative and Oncologic Outcomes. Clin Genitourin Cancer 2019; 17:e1048-e1053. [PMID: 31303560 DOI: 10.1016/j.clgc.2019.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/01/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this study was to compare perioperative and oncologic outcomes between laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BCa). MATERIALS AND METHODS Patients who underwent LRC or RARC with curative intent for BCa between January 2011 and December 2016 were included. Perioperative, pathologic oncologic data were extracted from our database. Disease-free survival, overall survival, and cancer-specific survival were analyzed using Kaplan-Meier survival curves with log-rank tests. RESULTS A total of 126 patients underwent LRC and 189 patients underwent RARC during the study period. All the baseline variables were similar between the two groups. Patients undergoing RARC had a significant higher median estimated blood loss (300 mL vs. 200 mL; P = .005), lower rate of 90-day postoperative complications (36.5% vs. 50.0%; P = .017), and higher median direct cost ($15,306 vs. $11,131; P < .001) than LRC. Other perioperative outcomes were similar. No differences were found in pathologic T stage, positive lymph nodes, or positive surgical margin between patients who underwent LRC and RARC. The 5-year disease-free survival, overall survival, and cancer-specific survival rates were 51.9%, 61.0%, and 69.5%, respectively, for all included patients. There were no significant differences in oncologic outcomes between the 2 groups. CONCLUSION Patients with BCa can be safely managed with LRC and RARC by experienced surgeons. RARC was associated with a reduced rate of postoperative complication but also with higher median estimated blood loss, and higher median direct cost. These findings could be used to guide patient counseling, and treatment selection.
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Affiliation(s)
- Shiqiang Su
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China; Department of Urology, The First Hospital of Shijiazhuang, Shijiazhuang, China
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Taoping Shi
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
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Adamczyk P, Juszczak K, Poblocki P, Mikolajczak W, Drewa T. Robot-assisted radical cystectomy - first Polish clinical outcomes. Cent European J Urol 2018; 71:14-20. [PMID: 29732201 PMCID: PMC5926646 DOI: 10.5173/ceju.2018.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/21/2018] [Accepted: 02/14/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Urothelial cell carcinoma is the most common neoplasm of the genito-urinary tract, which, in advanced stages, is treated with radical cystectomy with pelvic lymphadenectomy. It can be performed by an open or minimally invasive approach (laparoscopic and robot-assisted radical cystectomy). Large meta-analyses showed a significantly lower complication rate in the RARC (robot-assisted radical cystectomy) group compared to ORC (open radical cystectomy) in thirty and ninety days after surgery, with similar oncological and functional outcomes. The clinical outcomes of the first forty Polish RARC are explored in this article. Material and methods The Polish Radical Robotic Cystectomy Program (PRRC) was started in 2016 at the Nicolaus Copernicus Hospital in Toruń. Forty consecutive patients, with indications for cystectomy were included into the study. During radical robot-assisted cystectomy, obturator, external, internal, common iliac and presacral lymph nodes were dissected. Oncological outcomes, early complication rate, and the clinical variables were analyzed. Results The mean age in the study group was sixty-seven years, with the majority of patients being overweight and assessed as American Society of Anesthesiology Scale (ASA) – ASA III and ASA IV (2/3 of patients). RARC was performed, with the median time of surgery being 324 minutes (170 minutes being the shortest). Mean blood loss was 365 ml (lowest – 50 ml), and only 2 patients required intraoperative blood transfusion. Twenty patients had ileal conduit, and nineteen had other methods of urinary diversion. Only twenty-nine out of forty patients had minor complications (Clavien I and II), 11 had Clavien III and IV. Clavien V was not present. Only 3 patients required reoperation. Conclusions RARC is a reproducible oncological procedure, which can be safely performed in centers with robotic expertise, with acceptable operative time, complications, and functional and oncologic outcomes.
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Affiliation(s)
- Przemysław Adamczyk
- Nicolaus Copernicus Hospital in Toruń, Department of General and Oncologic Urology, Toruń, Poland
| | - Kajetan Juszczak
- Memorial Rydygier Hospital, Department of Urology, Cracow, Poland
| | - Pawel Poblocki
- Nicolaus Copernicus Hospital in Toruń, Department of General and Oncologic Urology, Toruń, Poland
| | - Witold Mikolajczak
- Nicolaus Copernicus Hospital in Toruń, Department of General and Oncologic Urology, Toruń, Poland
| | - Tomasz Drewa
- Nicolaus Copernicus Hospital in Toruń, Department of General and Oncologic Urology, Toruń, Poland.,Collegium Medicum of Nicolaus Copernicus University, Clinic of General and Oncologic Urology, Bydgoszcz, Poland
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Ko OS, Weiner AB, Smith ND, Meeks JJ. Rates and Predictors of Conversion to Open Surgery During Minimally Invasive Radical Cystectomy. J Endourol 2018; 32:488-494. [PMID: 29620960 DOI: 10.1089/end.2018.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the frequency of minimally invasive radical cystectomy (MIRC) conversion to open surgery, what factors influence conversion, whether or not the benefits of MIRC vs open radical cystectomy (ORC) persist after conversion, and compare ORC and MIRC outcomes. MATERIALS AND METHODS We performed a retrospective cohort study from the National Cancer Data Base (2010 to 2013) analyzing patients who underwent completed MIRC (n = 5750), converted MIRC (n = 245), and ORC (n = 12,053) without prior radiotherapy. Multivariable logistic and linear regression analyses were used to assess the association between covariates, open conversion as well as surgical approach, and secondary outcomes such as positive surgical margins (PSMs), use of lymphadenectomy, lymph node yield, hospital length of stay (LOS), and 30-day readmission. RESULTS Rates of conversion were independent of patient factors such as race, sex, use of neoadjuvant chemotherapy, and clinical stage. Conversion occurred in 245 of 5750 MIRCs (4.3%) and declined over time (5.8% in 2010 vs 3.2% in 2013, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.75, p = 0.001). MIRC was associated with fewer positive margins, higher lymph node yield, shorter LOS, and fewer readmissions compared with ORC, however, patients requiring open conversion had longer median hospital stays (8 days vs 7 days, p = 0.013), lower median lymph node yields (14 vs 17, p = 0.007), more PSMs (17% vs 11%, p = 0.006), and more 30-day readmissions (14% vs 9%, p = 0.008) compared to nonconverted. Converted MIRC had similar hospital LOS and 30-day readmission rates compared to ORC. CONCLUSION Open conversion during MIRC is uncommon and has decreased in recent years despite the rising use of MIRC. MIRC had better short-term outcomes compared with ORC. These benefits were negated with open conversion; however, outcomes were similar compared to planned ORC.
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Affiliation(s)
- Oliver S Ko
- 1 Department of Urology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Adam B Weiner
- 1 Department of Urology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Norm D Smith
- 2 Section of Urology, Department of Surgery, University of Chicago , Chicago Illinois
| | - Joshua J Meeks
- 1 Department of Urology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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Son SK, Lee NR, Kang SH, Lee SH. Safety and Effectiveness of Robot-Assisted Versus Open Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 27:1109-1120. [PMID: 28350238 DOI: 10.1089/lap.2016.0437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC) in bladder cancer. METHODS A literature search for the systematic review was conducted using international databases as well as domestic databases up to April 2015. Outcomes of interest included baseline characteristics, complication rates, perioperative, and oncologic outcomes. RESULTS Twenty-four articles were finally selected for inclusion in the meta-analysis. Complication rates of RARC were similar to those of ORC, except for 90-day overall complication rate, wound dehiscence, abscess, pneumonia, respiratory failure, and sepsis, which was lower after RARC. RARC was also associated with a smaller amount of estimated blood loss, lower transfusion rate, shorter length of hospital stay, shorter time to flatus, and more lymph node yield, whereas ORC was associated with a shorter operation time and lower rate of stricture. Considering oncologic outcomes, there were no differences between RARC and ORC. CONCLUSIONS RARC seems to be associated with equivalent complication rates, a smaller amount of estimated blood loss, lower transfusion rate, shorter length of hospital stay, shorter time to flatus, and more lymph node yield. Randomized controlled trials with a large sample size and comparative studies with long-term follow-up data are warranted to assess our findings and the oncologic effectiveness of RARC.
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Affiliation(s)
- Soo Kyung Son
- 1 Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,2 Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University , Seoul, Korea
| | - Na Rae Lee
- 1 Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.,2 Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University , Seoul, Korea
| | - Seok Ho Kang
- 3 Department of Urology, College of Medicine, Korea University , Seoul, Korea
| | - Seon Heui Lee
- 4 Department of Nursing Science, College of Nursing, Gachon University , Incheon, Korea
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15
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16
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Deboudt C, Perrouin-Verbe MA, Le Normand L, Perrouin-Verbe B, Buge F, Rigaud J. Comparison of the morbidity and mortality of cystectomy and ileal conduit urinary diversion for neurogenic lower urinary tract dysfunction according to the approach: Laparotomy, laparoscopy or robotic. Int J Urol 2016; 23:848-853. [DOI: 10.1111/iju.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Loic Le Normand
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation; University Hospital of Nantes; Nantes France
| | - François Buge
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Jérôme Rigaud
- Department of Urology; University Hospital of Nantes; Nantes France
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17
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Xia L, Wang X, Xu T, Zhang X, Zhu Z, Qin L, Zhang X, Fang C, Zhang M, Zhong S, Shen Z. Robotic versus open radical cystectomy: an updated systematic review and meta-analysis. PLoS One 2015; 10:e0121032. [PMID: 25825873 PMCID: PMC4380496 DOI: 10.1371/journal.pone.0121032] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 02/08/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC). METHODS A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in April 2014. All relevant studies comparing RARC with ORC were included for further screening. A pooled meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot. RESULTS Nineteen studies were included for the analysis, including a total of 1779 patients (787 patients in the RARC group and 992 patients in the ORC group). Although RARC was associated with longer operative time (p <0.0001), patients in this group might benefit from significantly lower overall perioperative complication rates within 30 days and 90 days (p = 0.005 and 0.0002, respectively), more lymph node yields (p = 0.009), less estimated blood loss (p <0.00001), lower need for perioperative and intraoperative transfusions (p <0.0001 and <0.0001, respectively), and shorter postoperative length of stay (p = 0.0002). There was no difference between two groups regarding positive surgical margin rates (p = 0.19). CONCLUSIONS RARC appears to be an efficient alternative to ORC with advantages of less perioperative complications, more lymph node yields, less estimated blood loss, lower need for transfusions, and shorter postoperative length of stay. Further studies should be performed to compare the long-term oncologic outcomes between RARC and ORC.
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Affiliation(s)
- Leilei Xia
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Xianjin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Tianyuan Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Xiaohua Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Zhaowei Zhu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Liang Qin
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Xiang Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Chen Fang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Minguang Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Shan Zhong
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
| | - Zhoujun Shen
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China
- * E-mail:
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18
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Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy. Eur Urol 2015; 67:402-22. [DOI: 10.1016/j.eururo.2014.12.008] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 11/20/2022]
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19
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Novara G, Catto JWF, Wilson T, Annerstedt M, Chan K, Murphy DG, Motttrie A, Peabody JO, Skinner EC, Wiklund PN, Guru KA, Yuh B. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol 2015; 67:376-401. [PMID: 25560798 DOI: 10.1016/j.eururo.2014.12.007] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 12/21/2022]
Abstract
CONTEXT Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity. OBJECTIVE To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted. EVIDENCE SYNTHESIS The searches retrieved 105 papers. According to the different diversion type, overall mean operative time ranged from 360 to 420 min. Similarly, mean blood loss ranged from 260 to 480 ml. Mean in-hospital stay was about 9 d for all diversion types, with consistently high readmission rates. In series reporting on RARC with either extracorporeal or intracorporeal conduit diversion, overall 90-d complication rates were 59% (high-grade complication: 15%). In series reporting RARC with intracorporeal continent diversion, the overall 30-d complication rate was 45.7% (high-grade complication: 28%). Reported mortality rates were ≤3% for all diversion types. Comparing RARC and ORC, cumulative analyses demonstrated shorter operative time for ORC, whereas blood loss and in-hospital stay were better with RARC (all p values <0.003). Moreover, 90-d complication rates of any-grade and 90-d grade 3 complication rates were lower for RARC (all p values <0.04), whereas high-grade complication and mortality rates were similar. CONCLUSIONS RARC can be performed safely with acceptable perioperative outcome, although complications are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas RARC may provide some advantages in terms of blood loss and transfusion rates and, more limitedly, for postoperative complication rates over ORC and LRC. PATIENT SUMMARY Although open radical cystectomy (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk of postoperative complications is high, including a substantial risk of major complication and reoperation.
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Affiliation(s)
- Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Italy.
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | | | | | - Kevin Chan
- City of Hope National Cancer Center Duarte, CA, USA
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria, Australia
| | | | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Eila C Skinner
- Department of Urology, Stanford University, Stanford, CA, USA
| | | | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Bertram Yuh
- City of Hope National Cancer Center Duarte, CA, USA
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20
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Pastore AL, Palleschi G, Silvestri L, Cavallaro G, Rizzello M, Silecchia G, de Nunzio C, Al-Rawashdah SF, Petrozza V, Carbone A. Pure intracorporeal laparoscopic radical cystectomy with orthotopic "U" shaped ileal neobladder. BMC Urol 2014; 14:89. [PMID: 25403723 PMCID: PMC4239397 DOI: 10.1186/1471-2490-14-89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background Radical cystectomy with pelvic lymph node dissection represents the standard treatment for muscle-invasive, and high-risk non-muscle-invasive bladder cancers. Aim of this study was to report our case series of 30 patients undergoing totally laparoscopic radical cystectomy (LRC) with reconstruction of an intracorporeal orthotopic ileal neobladder. Intra- and perioperative results and the functional and oncological outcomes 9 months after operation are reported. Methods Between October 2010 and December 2012, 30 male patients underwent LRC with a pure laparoscopic orthotopic ileal “U”- shaped neobladder diversion. The men had a median age of 67 years, a median body mass index of 22.3, and a mean ASA score of 2.2; they represented various clinical stages of disease. Results None of the patients required conversion to open surgery, and no perioperative mortalities were reported. The median operating time was 365 min, and the median blood loss was 290 mL, with a transfusion rate of 26.6%. All surgical margins were negative; 8 patients with non–organ-confined disease or positive lymph nodes received adjuvant chemotherapy. Early complications (within 30 days) occurred in 7 patients, and late complications occurred in 6 patients. The mean hospital stay was 9 days. At 9 months after surgery, the daytime continence rate was 83.3% and the nighttime continence rate was 73.3%. Conclusions Pure LRC with intracorporeal orthotopic ileal neobladder reconstruction may represent a viable alternative to open radical cystectomy, with a significant reduction in patient morbidity. Future, large, randomized controlled trials with extensive follow-up are needed to confirm our encouraging results.
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Affiliation(s)
- Antonio Luigi Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy.
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21
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Ishii H, Rai BP, Stolzenburg JU, Bose P, Chlosta PL, Somani BK, Nabi G, Qazi HAR, Rajbabu K, Kynaston H, Aboumarzouk OM. Robotic or Open Radical Cystectomy, Which Is Safer? A Systematic Review and Meta-Analysis of Comparative Studies. J Endourol 2014; 28:1215-23. [DOI: 10.1089/end.2014.0033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Hiro Ishii
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - Pradeep Bose
- Department of Urology, Moriston Hospital, Swansea, Wales, United Kingdom
| | | | - Bhaskar K. Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Ghulam Nabi
- Department of Urology, University of Dundee, Dundee, United Kingdom
| | | | | | - Howard Kynaston
- Department of Urology, University Hospital of Wales, Cardiff, United Kingdom
| | - Omar M. Aboumarzouk
- Department of Urology, University Hospital of Wales, Cardiff, United Kingdom
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22
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Aboumarzouk OM, Hughes O, Narahari K, Drewa T, Chlosta PL, Kynaston H. Safety and Feasibility of Laparoscopic Radical Cystectomy for the Treatment of Bladder Cancer. J Endourol 2013; 27:1083-95. [DOI: 10.1089/end.2013.0084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar M. Aboumarzouk
- Islamic University of Gaza, College of Medicine, Gaza, Palestine
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales
- Department of Urology, Jagiellonian University, Cracow, Poland
| | - Owen Hughes
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales
| | - Krishna Narahari
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales
| | - Tomasz Drewa
- Department of Tissue Engineering, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Urology, Nicolaus Copernicus Hospital, Torun, Poland
- Department of Urology, Institute of Oncology, Kielce, Poland
| | - Piotr L. Chlosta
- Department of Urology, Jagiellonian University, Cracow, Poland
- Department of Urology, the Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Howard Kynaston
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales
- Department of Surgery, Cardiff School of Medicine, Heath Park, Cardiff, Wales
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23
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Park B, Jeong BC, Jeon SS, Lee HM, Choi HY, Seo SI. Pure laparoscopic radical cystectomy with ileal conduit: a single surgeon's mid-term outcomes. Yonsei Med J 2013; 54:912-20. [PMID: 23709426 PMCID: PMC3663232 DOI: 10.3349/ymj.2013.54.4.912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The use of laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer is not yet widespread because of the technical difficulties of the procedure and the lengthy operating time. In this study, we report a single surgeon's experience with LRC. MATERIALS AND METHODS Thirty patients (25 men and 5 women) with bladder cancer underwent LRC and ileal conduit by a single surgeon between November 2007 and May 2011. An extracorporeal urinary diversion was performed through 5-6 cm midline incision for specimen extraction. RESULTS The median operating time and estimated blood loss were 527.5 minutes and 275 mL, respectively. There was no conversion to open surgery. The median time to oral intake and postoperative hospital stay were 5 days and 12 days, respectively. The rates of immediate, early postoperative and late postoperative complication were 3.3%, 20% and 20%, respectively. With 16 months of median follow- up, the overall and recurrence-free survival rates were 70% and 56.7%, respectively. CONCLUSION LRC is feasible for the management of invasive bladder cancer and, with appropriate patient selection, can be a good alternative to open or robot-assisted radical cystectomy in the era of robot-assisted surgery.
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Affiliation(s)
- Bumsoo Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute for Refractory Cancer Research, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Urology, Kangnam General Hospital, Yongin, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute for Refractory Cancer Research, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute for Refractory Cancer Research, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute for Refractory Cancer Research, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Institute for Refractory Cancer Research, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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24
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Punjani N, Lavallée LT, Momoli F, Fergusson D, Witiuk K, Mallick R, Morash C, Cagiannos I, Breau RH. Blood transfusion and hemostatic agents used during radical cystectomy. Can Urol Assoc J 2013; 7:E275-80. [PMID: 23766829 PMCID: PMC3668410 DOI: 10.5489/cuaj.1002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radical cystectomy may result in significant blood loss necessitating transfusion. The purpose of this study was to determine what intra-operative techniques and hemostatic agents are currently used by uro-oncologists to prevent and control blood loss during radical cystectomy. METHODS In August 2011, members of the Society of Urologic Oncology (SUO) were solicited to complete an online survey. Residents, fellows and non-urologists were excluded. Canadian members received a personal email invitation. Respondents were asked to provide demographic information and opinions regarding blood loss and transfusion. Participants were also asked to report techniques used to reduce blood loss. RESULTS Of the 34 Canadian SUO members with registered email addresses, 27 (79%) completed the survey and met inclusion criteria as staff urologists who perform radical cystectomy. In addition, 52 non-Canadian SUO members were included in the analysis. Among all SUO respondents, a high proportion (73; 88%) reported using topical hemostatic agents during cystectomy. Thirty-six (46%) surgeons reported occasionally using procedural techniques and 9 (11%) using systemic hemostatic agents. Number of years since training was associated with decreased use of topical agents and increased use of procedural techniques (p < 0.01). Number of cystectomies per year was associated with decreased use of topical hemostatic agents (p < 0.01). INTERPRETATION Based on a survey of practice, there is significant risk of blood loss requiring transfusion during radical cystectomy. Surgeons frequently use topical hemostatic agents and rarely use systemic drugs to prevent or control blood loss. Trials evaluating agents and techniques to reduce blood loss during radical cystectomy are needed.
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Affiliation(s)
- Nahid Punjani
- University of Ottawa Medical School, University of Ottawa, Ottawa, ON
| | - Luke T. Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | | | | | | | | | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON
| | - Rodney H. Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON
- Ottawa Hospital Research Institute, Ottawa, ON
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25
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Maes AA, Brunkhorst LW, Gavin PW, Todd SP, Maatman TJ. Comparison of robotic-assisted and open radical cystectomy in a community-based, non-tertiary health care setting. J Robot Surg 2013; 7:359-63. [PMID: 27001875 DOI: 10.1007/s11701-013-0401-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/29/2013] [Indexed: 12/22/2022]
Abstract
We examined the safety and feasibility of transitioning from open radical cystectomies to robotic-assisted laparoscopic cystectomies in a community-based, non-tertiary health care setting. A retrospective review and analysis of our most recent 14 unselected consecutive patients who underwent open cystectomy was compared to our first 14 unselected consecutive patients who underwent robotic-assisted laparoscopic cystectomy. Perioperative and pathologic outcomes were reviewed to determine the safety and oncologic equivalence of the two procedures. From 2003 to 2010, 14 consecutive patients underwent an open cystectomy and from 2010 to 2012 another 14 consecutive patients underwent a robotic-assisted laparoscopic cystectomy. The operative time was significantly longer in the robotic group (6 h 23 min vs. 4 h 28 min; p < 0.05) and intraoperative blood loss was significantly lower compared with the open radical cystectomy (ORC) group (470 ml vs. 942 ml; p < 0.05). Regarding complications, 21 % of robotic-assisted radical cystectomy (RARC) patients experienced major complications versus 14 % of ORC patients. Overall, there was no statistically significant difference in complication rates or length of hospital stay between the ORC and RARC groups. No pathologic differences were noted between the two groups and lymph node counts were similar in the two groups, with the median numbers being 11.9 and 9.5 in RARC and ORC, respectively. RARC can be accomplished in a community-based, non-tertiary health care setting without compromising perioperative or pathologic outcomes during the institution of this minimally invasive procedure.
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Abstract
The use of robotic assistance facilitates minimally invasive surgery and has been widely adopted across multiple specialties. This article reviews the published literature on use of this technology for treatment of oncologic conditions. PubMed searches were performed for articles published between 2000 and 2012 using the keywords "robotic" or "robotic surgery" in conjunction with "oncology" or "cancer." Although the most common use for robotics was to treat urologic oncologic conditions, it has also been widely adopted for gynecologic, general, thoracic, and head and neck surgeries. For several procedures, there is evidence that robotics offers short-term benefits such as shorter lengths of stay and lower intraoperative blood loss, with safety profiles and oncologic outcomes comparable to open or conventional laparoscopic approaches. However, long-term oncologic outcomes are generally lacking, and robotic surgeries are more costly than open or laparoscopic surgeries. Robotic technology is widely used in oncologic surgery with demonstrated short-term advantages. However, whether the benefits of robotics justify the higher costs warrant large comparative effectiveness studies with long-term outcomes.
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Affiliation(s)
- Hua-Yin Yu
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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28
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Ramirez JA, McIntosh AG, Strehlow R, Lawrence VA, Parekh DJ, Svatek RS. Definition, incidence, risk factors, and prevention of paralytic ileus following radical cystectomy: a systematic review. Eur Urol 2012; 64:588-97. [PMID: 23245816 DOI: 10.1016/j.eururo.2012.11.051] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/27/2012] [Indexed: 01/08/2023]
Abstract
CONTEXT Postoperative paralytic ileus (POI) has profound clinical consequences because it represents a substantial burden on both patients and health care resources. OBJECTIVE To determine the knowledge base regarding POI in the radical cystectomy (RC) population with an emphasis on preventive measures and risk factors. EVIDENCE ACQUISITION A systematic literature search of Medline (1966 to February 2011) and a study review were conducted. Eligible studies explicitly reported the incidence of POI and/or at least two quantitative measures of gastrointestinal recovery. EVIDENCE SYNTHESIS The search identified 727 relevant articles; 77 met eligibility criteria, comprising 13 793 patients. Of these, 21 used explicit definitions of POI, and they varied widely. Across studies, the incidence of POI ranged from 1.58% to 23.5%. Possible risk factors for POI included increasing age and body mass index. Seventeen studies reported effects of an intervention on POI: 3 randomized controlled studies, 11 observational cohort studies with concurrent comparison, and 3 observational cohort studies with nonconcurrent comparison. Gum chewing was associated with shortened times to flatus (2.4 vs 2.9 d; p<0.0001) and bowel movement (BM) (3.2 vs 3.9 d; p<0.001) in one observational cohort study (n=102); omission of a postoperative nasogastric tube (NGT) was associated with shorter time to flatus (4.21 vs 5.33 d; p=0.0001) and shorter length of stay (14.4 vs 19.1 d; p=0.001) in one observational cohort study (n=430); and the routine use of bowel preparation was associated with an increased incidence of POI (5% vs 19%) in another series (n=86). Additionally, readaptation of the dorsolateral peritoneal layer was shown to shorten times to flatus (p=0.016) and times to BM (p=0.011) in one randomized controlled study (n=200). CONCLUSIONS The incidence/definition of POI after RC is highly variable. An improved reporting strategy is needed to identify true incidence and risk factors, and to guide future research for both potential preventive and therapeutic interventions.
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Affiliation(s)
- Jorge A Ramirez
- Department of Urology, The University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
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Mmeje CO, Martin AD, Nunez-Nateras R, Parker AS, Thiel DD, Castle EP. Cost Analysis of Open Radical Cystectomy Versus Robot-assisted Radical Cystectomy. Curr Urol Rep 2012. [DOI: 10.1007/s11934-012-0292-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aboumarzouk OM, Drewa T, Olejniczak P, Chlosta PL. Laparoscopic Radical Cystectomy: a 5-year review of a single institute's operative data and complications and a systematic review of the literature. Int Braz J Urol 2012; 38:330-40. [DOI: 10.1590/s1677-55382012000300006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2012] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Piotr L. Chlosta
- Institute of Oncology UJK University, Poland; Medical Centre of Postgraduate Education, Poland
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Oncological and Functional Outcomes After Robot-assisted Radical Cystectomy: Critical Review of Current Status. Urology 2011; 78:977-84. [DOI: 10.1016/j.urology.2011.04.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 03/10/2011] [Accepted: 04/22/2011] [Indexed: 11/20/2022]
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Cost-effectiveness of open versus laparoscopic versus robotic-assisted laparoscopic cystectomy and urinary diversion. Curr Opin Urol 2011; 21:415-9. [DOI: 10.1097/mou.0b013e3283490582] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Richards KA, Hemal AK. Current status and outcomes of robot-assisted laparoscopic radical cystectomy and urinary diversion. Curr Urol Rep 2011; 12:107-14. [PMID: 21207209 DOI: 10.1007/s11934-010-0162-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Robot-assisted laparoscopic radical cystectomy (RARC) has emerged as a viable treatment option for patients with muscle-invasive bladder cancer and select patients with high-risk nonmuscle invasive disease. Operative, perioperative, and intermediate-term oncologic outcomes for RARC from multiple single-institution reports and from multi-institutional studies appear promising. Long-term oncologic outcomes for RARC should be forthcoming in the years ahead. As technology improves, total intracorporeal urinary diversion may become easier to perform and less time-consuming. This article aims to review the most recent developments within the past 1 to 2 years surrounding RARC, important technical nuances for performing this operation, and the future direction of RARC.
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Affiliation(s)
- Kyle A Richards
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
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Orvieto MA, Marchetti P, Castillo OA, Coelho RF, Chauhan S, Rocco B, Ardila B, Mathe M, Patel VR. Robotic technologies in surgical oncology training and practice. Surg Oncol 2011; 20:203-9. [PMID: 21353772 DOI: 10.1016/j.suronc.2010.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985, the technology has dramatically evolved and currently multiple surgical specialties have incorporated RS into their daily clinical armamentarium. With this exponential growth, it should not come as a surprise the ever growing requirement for surgeons trained in RS as well as the interest from residents to receive robotic exposure during their training. For this reason, the establishment of set criteria for adequate and standardized training and credentialing of surgical residents, fellows and those trained surgeons wishing to perform RS has become a priority. In this rapidly evolving field, we herein review the past, present and future of robotic technologies and its penetration into different surgical specialties.
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Affiliation(s)
- Marcelo A Orvieto
- Florida Hospital - Celebration Health, 410 Celebration Place, Suite 200, Celebration, FL 34747, USA.
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Kaufmann OG, Young JL, Sountoulides P, Kaplan AG, Dash A, Ornstein DK. Robotic radical anterior pelvic exenteration: The UCI experience. MINIM INVASIV THER 2010; 20:240-6. [DOI: 10.3109/13645706.2010.541711] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Martin AD, Nunez RN, Castle EP. Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology 2010; 77:621-5. [PMID: 21122900 DOI: 10.1016/j.urology.2010.07.502] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/15/2010] [Accepted: 07/31/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To perform a complete cost analysis comparing robot assisted radical cystectomy (RARC) versus open radical cystectomy (ORC). MATERIAL AND METHODS After institutional review board approval for data collection, we prospectively recorded perioperative outcomes and costs, such as hospital stay, transfusion rate, readmission rate, and medications for consecutive patients undergoing RARC or ORC. Using actual cost data, we developed a cost decision tree model to determine typical perioperative costs for both RARC and ORC. Multivariate sensitivity analysis was performed to elucidate which variables had the greatest impact on overall cost. Breakeven points with ORC were calculated using our model to better evaluate variable influence. In addition to the above modeled analysis, actual patient costs, including complications 30 days from surgery, were also compared for each procedure. RESULTS Our model analysis showed that operative time and length of stay had the greatest impact on perioperative costs. Robotic cystectomy became more expensive than open cystectomy at the following break-even points: operating room (OR) time greater than 361 minutes, length of stay greater than 6.6 days, or robotic OR supply cost exceeding $5853. RARC was 16% more expensive when only comparing direct operative costs. Interestingly, actual total patient costs revealed a 38% cost advantage favoring RARC due to increased hospitalization costs for ORC in our cohort. CONCLUSIONS RARC can provide a cost-effective alternative to ORC with operative time and length of stay being the most critical cost determinants. Higher complication rates with ORC make total actual costs much higher than RARC.
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Affiliation(s)
- Aaron D Martin
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85022, USA.
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Kauffman EC, Ng CK, Lee MM, Otto BJ, Wang GJ, Scherr DS. Early oncological outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy. BJU Int 2010; 107:628-35. [PMID: 20883479 DOI: 10.1111/j.1464-410x.2010.09577.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eric C Kauffman
- Department of Urology, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA.
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Davis JW, Castle EP, Pruthi RS, Ornstein DK, Guru KA. Robot-assisted radical cystectomy: An expert panel review of the current status and future direction. Urol Oncol 2010; 28:480-6. [DOI: 10.1016/j.urolonc.2009.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 11/19/2009] [Accepted: 11/20/2009] [Indexed: 10/19/2022]
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Weizer AZ, Montgomery JS. The Role of Lymphadenectomy in Minimally Invasive Urologic Oncology. J Endourol 2010; 24:1229-40. [DOI: 10.1089/end.2009.0562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alon Z. Weizer
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey S. Montgomery
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
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Robot-assisted Pelvic Lymphadenectomy for Bladder Cancer—Where Have We Reached By 2009. Urology 2010; 75:1269-74. [DOI: 10.1016/j.urology.2009.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 10/29/2009] [Accepted: 11/06/2009] [Indexed: 11/22/2022]
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Kauffman EC, Ng CK, Lee MM, Otto BJ, Portnoff A, Wang GJ, Scherr DS. Critical analysis of complications after robotic-assisted radical cystectomy with identification of preoperative and operative risk factors. BJU Int 2010; 105:520-7. [PMID: 19735257 DOI: 10.1111/j.1464-410x.2009.08843.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eric C Kauffman
- Department of Urology, Weill Cornell Medical Center, New York, NY, USA.
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Gamboa AJ, Young JL, Dash A, Abraham JB, Box GN, Ornstein DK. Pelvic lymph node dissection and outcome of robot-assisted radical cystectomy for bladder carcinoma. J Robot Surg 2009; 3:7-12. [PMID: 25484987 PMCID: PMC4247420 DOI: 10.1007/s11701-009-0124-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 01/08/2009] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Pelvic lymph node dissection (PLND) at the time of radical cystectomy for urothelial carcinoma of the bladder is critical for accurate staging and may improve oncologic outcomes. Minimally invasive approaches have been criticized for limiting the extent of the PLND. We reviewed our experience with PLND and its perioperative outcomes with robot-assisted laparoscopic radical cystectomy (RARC). METHODS Data were collected prospectively from 50 patients scheduled for RARC. Included in the analysis were patients who had RARC and a standard PLND. The entire extirpative portion of the procedure was performed using the da Vinci Robot (Intuitive Surgical, Sunnyvale, CA, USA). RESULTS A total of 41 patients were included in the study: 30 men and 11 women with a mean age of 69.7 years (range 49-85) and a mean body mass index of 26.9 (range 19.5-43.7). The median total operative time was 497.77 min (320-805). The mean estimated blood loss was 253.66 ml (range 50-700). The transfusion rate was 44% (18 out of 41) ranging from 0 to 4 units (median 0 units of blood). The mean total number of lymph nodes retrieved was 25.07 (range 4-68). Nodal metastases were seen in 14.63% (6/41). Rate of positive surgical margin was 4.87% (2/41). The median length of hospital stay was 8 days (5-37). The median duration of nasogastric tube, time to ambulation, first clear liquid intake, passage of colonic gas, time to bowel movement, and start of solid food intake were 1 (0-5), 2 (1-7), 3 (2-10), 4 (1-6), 5 (2-11) and 6 days (3-24), respectively. CONCLUSION An adequate PLND, comparable with that recommended for open surgery, can be performed safely with robot assistance. The perioperative outcomes were likewise comparable with that of the gold standard, open cystectomy.
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Affiliation(s)
- Aldrin J. Gamboa
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Jennifer L. Young
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Atreya Dash
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Jose Benito Abraham
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Geoffrey N. Box
- Ohio State University, 540 Doan Hall, 410 W. 10th Ave Columbus, Columbus, OH 43210 USA
| | - David K. Ornstein
- Vanguard Urologic Institute, 6400 Fannin St., Suite 2300, Houston, TX 77030 USA
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Hemal AK. Robotic and laparoscopic radical cystectomy in the management of bladder cancer. Curr Urol Rep 2009; 10:45-54. [DOI: 10.1007/s11934-009-0009-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kang SC, Kang SG, Choi H, Ko YH, Lee JG, Kim JJ, Kang SH, Cheon J. The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.9.870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seung Chul Kang
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Hoon Choi
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jun Cheon
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
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