1
|
Yokoyama M, Chen W, Waseda Y, Fujiwara M, Kato D, Shirakawa T, Shimizu Y, Nenohi T, Matsumoto Y, Okumura T, Urushibara M, Ai M, Fushimi K, Fukagai T, Eto M, Fujii Y, Ishizaka K. Comparisons of in-hospital fee and surgical outcomes between robot-assisted, laparoscopic, and open radical cystectomy: a Japanese nationwide study. Jpn J Clin Oncol 2024; 54:822-826. [PMID: 38553780 DOI: 10.1093/jjco/hyae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/11/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE To evaluate in-hospital fees and surgical outcomes of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) using a Japanese nationwide database. METHODS All data were obtained from the Diagnosis Procedure Combination database between April 2020 and March 2022. Basic characteristics and perioperative indicators, including in-hospital fees, were compared among the RARC, LRC and ORC groups. Propensity score-matched comparisons were performed to assess the differences between RARC and ORC. RESULTS During the study period, 2931, 1311 and 2435 cases of RARC, LRC and ORC were identified, respectively. The RARC group had the lowest in-hospital fee (median: 2.38 million yen), the shortest hospital stay (26 days) and the lowest blood transfusion rate (29.5%), as well as the lowest complication rate (20.9%), despite having the longest anesthesia time (569 min) among the three groups (all P < 0.01). The outcomes of LRC were comparable with those of RARC, and the differences in these indicators between the RARC and ORC groups were greater than those between the RARC and LRC groups. In propensity score-matched comparisons between the RARC and ORC groups, the differences in the indicators remained significant (all P < 0.01), with an ~50 000 yen difference in in-hospital fees. CONCLUSIONS RARC and LRC were considered to be more cost-effective surgeries than ORC due to their superior surgical outcomes and comparable surgical fees in Japan. The widespread adoption of RARC and LRC is expected to bring economic benefits to Japanese society.
Collapse
Affiliation(s)
- Minato Yokoyama
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo
| | - Wei Chen
- Department of Urology, Tokyo Medical and Dental University, Tokyo
| | - Yuma Waseda
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo
- Department of Urology, Tokyo Medical and Dental University, Tokyo
| | | | - Daisuke Kato
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Takeshi Shirakawa
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Yohei Shimizu
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Tsunehiro Nenohi
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Yuki Matsumoto
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Taisuke Okumura
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Masayasu Urushibara
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| | - Masumi Ai
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo
| | - Takashi Fukagai
- Department of Urology, Showa University School of Medicine, Tokyo
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo
| | - Kazuhiro Ishizaka
- Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki City
| |
Collapse
|
2
|
Davidson T, Sjödahl R, Aldman Å, Lennmarken C, Kammerlind AS, Theodorsson E. Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes. Scand J Surg 2024; 113:13-20. [PMID: 37555486 DOI: 10.1177/14574969231186283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND AIM The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations. METHODS A narrative review was carried out. RESULTS When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs. CONCLUSIONS Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.
Collapse
Affiliation(s)
- Thomas Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE 58183, Linkoping Sweden
| | - Rune Sjödahl
- Division of Surgery and Clinical Experimental Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Åke Aldman
- Department of Surgery, Region Kalmar län, Kalmar, Sweden
| | - Claes Lennmarken
- Department for Medical Quality, Region Östergötland, Linkoping, Sweden
| | - Ann-Sofi Kammerlind
- Futurum, Jönköping, Sweden Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| |
Collapse
|
3
|
Katsimperis S, Tzelves L, Tandogdu Z, Ta A, Geraghty R, Bellos T, Manolitsis I, Pyrgidis N, Schulz GB, Sridhar A, Shaw G, Kelly J, Skolarikos A. Complications After Radical Cystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials with a Meta-regression Analysis. Eur Urol Focus 2023; 9:920-929. [PMID: 37246124 DOI: 10.1016/j.euf.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/14/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
CONTEXT Radical cystectomy is considered a procedure of high complexity with a relative high complication rate. OBJECTIVE To systematically summarize the literature regarding the complications of radical cystectomy and the factors that contribute to them. EVIDENCE ACQUISITION We searched MEDLINE/PubMed, ClinicalTrials.gov, and Cochrane Library, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for randomized controlled trials (RCTs) on complications related to radical cystectomy. EVIDENCE SYNTHESIS A total of 3766 studies were screened, and 44 studies were included in this systematic review and meta-analysis. Complications following radical cystectomy are quite common. The most common complications were gastrointestinal complications (20%), infectious complications (17%), and ileus (14%). The majority of complications occurring were Clavien I-II (45%). Specific measurable patient factors are related to certain complications and can be used to stratify risk and assist in preoperative counseling, while proper design of high-quality RCTs may better reflect real-life complication rates. CONCLUSIONS In our study, RCTs with a low risk of bias had higher complication rates than studies with a high risk of bias, underlining the need for further improvement on complication reporting in order to refine surgical outcomes. PATIENT SUMMARY Radical cystectomy is usually followed by high complication rates, which affect patients and are, in turn, strongly associated with patients' preoperative health status.
Collapse
Affiliation(s)
| | - Lazaros Tzelves
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Zafer Tandogdu
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Anthony Ta
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, England
| | | | | | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Ashwin Sridhar
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - Gregory Shaw
- University College of London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- University College of London Hospitals NHS Foundation Trust, London, UK
| | | |
Collapse
|
4
|
Tzelves L, Geraghty RM, Hughes T, Juliebø-Jones P, Somani BK. Innovations in Kidney Stone Removal. Res Rep Urol 2023; 15:131-139. [PMID: 37069942 PMCID: PMC10105588 DOI: 10.2147/rru.s386844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
Urolithiasis is a common clinical condition, and surgical treatment is performed with different minimally invasive procedures, such as ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy. Although the transition from open surgery to endourological procedures to treat this condition has been a paradigm shift, ongoing technological advancements have permitted further improvement of clinical outcomes with the development of modern equipment. Such innovations in kidney stone removal are new lasers, modern ureteroscopes, development of applications and training systems utilizing three-dimensional models, artificial intelligence and virtual reality, implementation of robotic systems, sheaths connected to vacuum devices and new types of lithotripters. Innovations in kidney stone removal have led to an exciting new era of endourological options for patients and clinicians alike.
Collapse
Affiliation(s)
- Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| |
Collapse
|
5
|
Robot-assisted vs open radical cystectomy: Systematic review and meta-analysis of randomized controlled trials. Actas Urol Esp 2023:S2173-5786(23)00016-1. [PMID: 36842704 DOI: 10.1016/j.acuroe.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 02/26/2023]
|
6
|
Wang Y, Lu X, Gao Y, Liu N, Jiang H, Chen S, Chen M. The predictive value of prognostic nutritional index on early complications after robot-assisted radical cystectomy. Front Surg 2022; 9:985292. [DOI: 10.3389/fsurg.2022.985292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
ObjectiveThe purpose of the study was to evaluate the predictive value of prognostic nutritional index (PNI) on early complications (within 30-day) after robot-assisted radical cystectomy (RARC) and urinary diversion.Patients and methodsPatients underwent RARC and urinary diversion between November 2018 and December 2021 in our centre were screened in this retrospective study. Baseline characteristics and perioperative data were recorded. Early complications after surgery were classified according to Clavien-Dindo system. Univariate and multivariate logistic analysis were performed to decide the potential factors associated with post-RARC complications. The receiver operating characteristic (ROC) curve was conducted to determine the predictive value of PNI on early overall and major complications after RARC.ResultsOverall 139 men and 13 women with a median age of 69 years and mean BMI of 24.4 kg/m2 were included in this study. As for urinary diversion, most patients (n = 111, 73%) received cutaneous ureterostomy, 36 patients (23.7%) underwent orthotopic neobladder and 5 patients (3.3%) received ileal conduit. The incidence of postoperative complication rate was 44.7%, which included 82.2% minor complications and 17.8% major complications. Further univariate and multivariate logistic analyses demonstrated that hypertension (OR = 2.96, 95% CI: 1.24–7.07, P = 0.015), PNI (OR = 0.73, 95% CI: 0.62–0.86, P < 0.001), and CCI (OR = 1.44, 95% CI: 1.01–2.06, P = 0.047) were independent risk factors of early complications after RARC. Moreover, PNI (OR = 0.72, 95% CI: 0.60–0.86, P < 0.001) was also the predictor of major complications after RARC. The ROC curve demonstrated that PNI (AUC = 0.829; AUC = 0.840) has a great predictive value in early overall and major complications after RARC.ConclusionPNI can be an early alert for RARC patients thus aiding in closer monitoring and postoperative management.
Collapse
|
7
|
Mally D, Pfister D, Heidenreich A, Albers P, Niegisch G. [Does robotic radical cystectomy affect oncological outcomes in bladder cancer patients?]. Aktuelle Urol 2022; 53:153-158. [PMID: 35345013 DOI: 10.1055/a-1745-8521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.
Collapse
Affiliation(s)
- David Mally
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
8
|
Grauer R, Wiklund NP. Update on robotic cystectomy. Curr Opin Urol 2021; 31:537-541. [PMID: 34506337 DOI: 10.1097/mou.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article aims to discuss recently published (2019-2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics. RECENT FINDINGS RARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming. SUMMARY ORC is the current 'gold standard' management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed-informing further adoption of the technique.
Collapse
Affiliation(s)
- Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | |
Collapse
|
9
|
Kessler ER, Kukreja JB, Geiger CL, Fischer SM. Treating Elderly Patients With Muscle-Invasive Bladder Cancer. J Natl Compr Canc Netw 2021; 18:783-790. [PMID: 32502977 DOI: 10.6004/jnccn.2020.7585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
Bladder cancer is an extremely common cancer that primarily affects individuals aged >65 years. In caring for patients with bladder cancer, clinicians must also consider care of older persons in general. Management of muscle-invasive bladder cancer (MIBC) involves multidisciplinary treatment planning, because curative-intent therapy includes either surgery or radiation, with consideration of the role of systemic therapy. As clinicians develop a treatment plan, considering a geriatric oncology perspective may enhance patient care and influence outcomes for this large and growing population. Similarly, treatment plan development must also consider aspects unique to an older patient population, such as altered organ function, increased comorbidity, decreased functional reserve, and perhaps altered goals of treatment. Thus a thorough evaluation inclusive of disease assessment and geriatric assessment is essential to care planning. Population-based data show that as patients with MIBC age, use of standard therapies declines. Given the complexities of coordinating a multidisciplinary care plan, as well the complexities of treating a heterogeneous and potentially vulnerable older patient population, clinicians may benefit from upfront assessments to inform and guide the process. This review highlights the unique treatment planning considerations for elderly patients diagnosed with MIBC.
Collapse
Affiliation(s)
- Elizabeth R Kessler
- 1Division of Medical Oncology, University of Colorado School of Medicine.,2University of Colorado Cancer Center; and
| | - Janet B Kukreja
- 2University of Colorado Cancer Center; and.,3Department of Urology and
| | - Christopher L Geiger
- 1Division of Medical Oncology, University of Colorado School of Medicine.,2University of Colorado Cancer Center; and
| | - Stacy M Fischer
- 2University of Colorado Cancer Center; and.,4Division of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
10
|
Katayama S, Mori K, Pradere B, Mostafaei H, Schuettfort VM, Quhal F, Motlagh RS, Laukhtina E, Moschini M, Grossmann NC, Nasu Y, Shariat SF, Fajkovic H. Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis. Int J Clin Oncol 2021; 26:1587-1599. [PMID: 34146185 PMCID: PMC8364906 DOI: 10.1007/s10147-021-01972-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/13/2021] [Indexed: 12/29/2022]
Abstract
This
systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and extracorporeal (ECUD) urinary diversion following robot-assisted radical cystectomy (RARC). A systematic literature search of articles was performed in PubMed®, Web of Science®, and Scopus® databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We included studies that compared patients who underwent RARC with ICUD to those with ECUD. Twelve studies including 3067 patients met the eligibility criteria. There were no significant differences between ICUD and ECUD in overall and major complications, regardless of the period (short-term [≤ 30 days] or mid-term [> 30 days]). Subgroup analyses demonstrated that ICUD performed by high-volume centers exhibited a significantly reduced risk of major complications (short-term: OR 0.57, 95% CI 0.37–0.86, p = 0.008, mid-term: OR 0.66, 95% CI 0.46–0.94, p = 0.02). Patients who underwent ICUD had lower estimated blood loss (MD -102.3 ml, 95% CI − 132.8 to − 71.8, p < 0.00001), less likely to receive blood transfusion rates (OR 0.36, 95% CI 0.20–0.62, p = 0.00003); and these findings were consistent in subgroup analyses by low-volume centers (MD-121.6 ml, 95% CI − 160.9 to − 82.3, p < 0.00001 and OR 0.36, 95% CI 0.20–0.62, p = 0.00003, respectively). ICUD had a higher lymph node yield (MD 3.68, 95% CI 0.80–6.56, p = 0.01). Patients receiving ICUD provided comparable complications, superior perioperative outcomes, and similar oncological outcomes compared with ECUD. Centralization of patients may contribute to a reduction of postoperative complications, while maintaining the advantages.
Collapse
Affiliation(s)
- Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Hospital of Tours, Tours, France
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Nico C Grossmann
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
| |
Collapse
|
11
|
Zeuschner P, Linxweiler J, Mohr R, van Heemskerk S, Wagenpfeil G, Wagenpfeil S, Ohlmann C, Siemer S, Stöckle M, Saar M. Robot-assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience. Int J Med Robot 2021; 17:e2258. [PMID: 33826236 DOI: 10.1002/rcs.2258] [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: 03/17/2021] [Revised: 03/17/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Most comparisons of robot-assisted (RARC) versus open radical cystectomy (ORC) for urothelial carcinoma do not factor the inherent stage selection bias or surgical experience. METHODS We compared the perioperative outcomes of 229 RARC and 335 ORC at a single tertiary referral centre with propensity score matching and multiple regression models, when controlling for tumour and patient characteristics, surgeon's experience and type of urinary diversion. RESULTS RARC had less major complications (19.8% vs. 34.1%) and ICU admissions (6.6% vs. 19.8%), with lower blood loss (400 vs. 500 ml) and transfusion rates. The operating time was longer (336 vs. 286 min), but decreased with surgeon's experience. RARC had less positive surgical margins (3% vs. 8.4%) and a higher lymph node count (14 vs. 11). CONCLUSIONS In this large single centre series comparing RARC with ORC controlling for stage selection bias and surgical experience, RARC proved significantly better outcomes, especially with intracorporeal urinary diversion.
Collapse
Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Rebecca Mohr
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Sara van Heemskerk
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Carsten Ohlmann
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| |
Collapse
|
12
|
Feng D, Tang Y, Yang Y, Han P, Wei W. Intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy: evidence from a systematic review and pooled analysis of observational studies. MINERVA UROL NEFROL 2020; 72:519-530. [DOI: 10.23736/s0393-2249.20.03829-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
13
|
Yee CH, Yuen-Chun J, Chan ESY. Current evidence for robotic surgery in radical cystectomy. Turk J Urol 2020; 47:S1-S8. [PMID: 32976090 DOI: 10.5152/tud.2020.20355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Robotic-assisted radical cystectomy (RARC) has been gaining momentum as an alternative to its conventional open radical cystectomy (ORC) for the management of invasive bladder cancer. Although RARC, in general, demonstrated less blood loss and shorter hospital stay than ORC, whether there is any significant difference in the overall complication rate still requires further investigation. Thus, both RARC and ORC share a similar oncology outcome, with comparable positive surgical margin rates, disease-free survival, and overall survival. Techniques of intracorporeal urinary diversion (ICUD) have not yet been standardized. ICUD may result in a lower risk of ureteroileal anastomotic stricture than extracorporeal urinary diversion (ECUD). However, ECUD is still a valid and commonly practiced option according to the available data. In general, RARC has been demonstrated to provide promising results. Long-term data and functional outcome after RARC and ICUD are needed to further validate the role of RARC in the management of bladder cancer.
Collapse
Affiliation(s)
- Chi Hang Yee
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Jeremy Yuen-Chun
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Eddie Shu-Yin Chan
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
14
|
Venkatramani V, Parekh DJ. Editorial Comment on: Does the Use of the Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open to Robotic Counterparts by Tzelves et al. (From: Tzelves L, Skolarikos A, Mourmouris P, et al. J Endourol 2019;33:971-984; DOI: 10.1089/end.2019.0226). J Endourol 2019; 33:985. [PMID: 31544492 DOI: 10.1089/end.2019.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vivek Venkatramani
- Department of Urology, University of Miami Miller School of Medicine, Coral Gables, Florida
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Coral Gables, Florida
| |
Collapse
|