Abstract：
To compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer.
Retrospective revision of 43 patients who underwent RARC for bladder cancer between 2015-2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy.
Forty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 minutes (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, P=.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, P=.044).
RARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.
Retrospective revision of 43 patients who underwent RARC for bladder cancer between 2015-2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy.
Forty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 minutes (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, P=.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, P=.044).
RARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.
摘要：
比较机器人辅助根治性膀胱切除术(RARC)与体外膀胱切除术(ECUD)的围手术期疗效及并发症体内尿流改道（ICUD）治疗膀胱癌。
回顾性修订了2015-2018年间接受RARC治疗的43例膀胱癌患者，随访至少3个月。分析包括由一位在开放根治性膀胱切除术中具有丰富经验的外科医生进行的RARC的初始系列。
43名患者,40名男性（93％）和3名女性（7％），中位年龄为65岁(44-83岁),平均随访时间为27.7个月(±20.1),接受RARC治疗.22例（51％）进行了ECUD，其中10个是回肠导管(45.5%)和12个新膀胱(54.5)，和ICUD21例(49%)，其中14个为回肠导管（66.7％）和7个新膀胱（33.3％）。两组的临床和术前特征相似。中位手术时间为360分钟（240-540），住院时间为12天（7-73）。35例患者（81%）有术后并发症，其中10人(23%)是主要的。手术时间,围手术期并发症,病理阶段,正利润率，两组之间的淋巴结切除数量没有显着差异。接受ECUD的患者输尿管回肠狭窄的发生率高于患有ICUD的患者（45.5％vs.14.3%,P=.026）。在新生者中，与ICUD相比，ECUD的尿道新膀胱狭窄率更高(33%vs.0%,P=.044）。
与ECUD相比，RARC与ICUD的围手术期结果和并发症发生率相当。ICUD可以降低输尿管回肠和尿道新膀胱狭窄的风险。
回顾性修订了2015-2018年间接受RARC治疗的43例膀胱癌患者，随访至少3个月。分析包括由一位在开放根治性膀胱切除术中具有丰富经验的外科医生进行的RARC的初始系列。
43名患者,40名男性（93％）和3名女性（7％），中位年龄为65岁(44-83岁),平均随访时间为27.7个月(±20.1),接受RARC治疗.22例（51％）进行了ECUD，其中10个是回肠导管(45.5%)和12个新膀胱(54.5)，和ICUD21例(49%)，其中14个为回肠导管（66.7％）和7个新膀胱（33.3％）。两组的临床和术前特征相似。中位手术时间为360分钟（240-540），住院时间为12天（7-73）。35例患者（81%）有术后并发症，其中10人(23%)是主要的。手术时间,围手术期并发症,病理阶段,正利润率，两组之间的淋巴结切除数量没有显着差异。接受ECUD的患者输尿管回肠狭窄的发生率高于患有ICUD的患者（45.5％vs.14.3%,P=.026）。在新生者中，与ICUD相比，ECUD的尿道新膀胱狭窄率更高(33%vs.0%,P=.044）。
与ECUD相比，RARC与ICUD的围手术期结果和并发症发生率相当。ICUD可以降低输尿管回肠和尿道新膀胱狭窄的风险。
