Objective:We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures(UES)following robot-assisted radical cystectomy(RARC)and urinary diversion.Methods:Retrospective review of our R...Objective:We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures(UES)following robot-assisted radical cystectomy(RARC)and urinary diversion.Methods:Retrospective review of our RARC database from November 2005 to August 2023 at Roswell Park Comprehensive Cancer center was performed.Patients who developed UES and ultimately underwent robot-assisted uretero-enteric reimplantation(RUER)were identified.KaplaneMeier method was used to compute the cumulative incidence recurrence rate of UES after RUER.A multivariable regression model was used to identify variables associated with UES recurrence.Results:A total of 123(15%)out of 808 RARC patients developed UES,of whom 52 underwent reimplantation(45 patients underwent RUER[n=55 cases]and seven patients underwent open ureteroenteric reimplantation).The median time from RARC to UES was 4.4(interquartile range 3.0e7.0)months,and the median time between UES and RUER was 5.2(interquartile range 3.2e8.9)months.The 3-year recurrence rate after RUER is about 29%.On multivariable analysis,longer hospital stay(hazard ratio 1.37,95%confidence interval 1.16e1.61,p<0.01)was associated with recurrent UES after RUER.Conclusion:RUER for UES after RARC is feasible with durable outcomes although a notable subset of patients experienced postoperative complications and UES recurrence.展开更多
Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE)....Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .展开更多
Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postopera...Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).展开更多
Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Method...Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.展开更多
Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological an...Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.展开更多
Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Pati...Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage,increased nodal involvement,similar complications outcomes,decreased overall survival,and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion.展开更多
Introduction and Objective: Laparoscopic radical cystectomy (LRC) is an alternative to open approach with lower morbidity and better oncologic outcome. We aim to share our experience on laparoscopic radical cystectomy...Introduction and Objective: Laparoscopic radical cystectomy (LRC) is an alternative to open approach with lower morbidity and better oncologic outcome. We aim to share our experience on laparoscopic radical cystectomy and to evaluate our morbidity and oncological outcome in our settings. Methodology: An observational study in the Douala Medico-Surgical Urology Centre on 5 patients who underwent laparoscopic cystectomy with or without lymph node dissection and external urine diversion between April 2014 to July 2016 was conducted. The overall survival rate was subsequently estimated. Results: Four men and one woman underwent laparoscopic radical cystectomy during the 5-year study period with a mean age of 54.5-year-old. Three patients were submitted to ileal conduits, one to neobladders, and one patient to uretero-cutaneostomies. The mean operative time was 300 ± 17 minutes and the mean length of hospital stay was 9 ± 3 days. Three patients had minor complications according to Clavien and Dindon Classification treated conservatively without need for further operation. Four patients had transitional cell carcinoma and one Squamous cell carcinoma types. Everyone had negative resection margin while only two had negative lymph node. The median survival years in our study was 2.5 years, the overall survival rates at 2 years were 60%, 40% at 3 years and 20 at 5years. 2 patients die after one year due to renal failure and intercurrent disease. Conclusion: Laparoscopic radical cystectomy carried lower morbidity and cancerological outcome compare to open surgery making it a good alternative for bladder oncologic surgery.展开更多
Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the ...Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.展开更多
Robotic-assisted radical prostatectomy(RARP)is the current standard of care with long term cure in organ-confined disease.The introduction of nerve-sparing(NS)to standard RARP has shown positive results in terms of fu...Robotic-assisted radical prostatectomy(RARP)is the current standard of care with long term cure in organ-confined disease.The introduction of nerve-sparing(NS)to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes.This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes,the neurovascular bundle(NVB),various NS techniques and postoperative functional outcomes.A non-systematic review was done using PubMed,Embase and Medline databases to retrieve and analyse articles in English,with following keywords“prostate cancer”,“robotic radical prostatectomy”,“nerve-sparing”.The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies.The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other.Variables such as preoperative risk assessments,baseline potency,surgical anatomy of individual patients and surgeons’expertise play a major role in the outcomes.A tailored approach for each patient is required for applying the NS approach during RARP.展开更多
Several recent studies have reported the involvement of bladder dysfunction in the delayed recovery of urinary continence following radical prostatectomy （RP）. The objective of this study was to investigate the sign...Several recent studies have reported the involvement of bladder dysfunction in the delayed recovery of urinary continence following radical prostatectomy （RP）. The objective of this study was to investigate the significance of detrusor overactivity （DO） as a predictor of the early continence status following robot-assisted RP （RARP）. This study included 84 consecutive patients with prostate cancer undergoing RARP. Urodynamic studies, including filling cystometry, pressure flow study, electromyogram of the external urethral sphincter and urethral pressure profile, were performed in these patients before surgery. Urinary continence was defined as the use of either no or one pad per day as a precaution only. DO was preoperatively observed in 30 patients （35.7%）, and 55 （65.5%） and 34 （40.5%） were judged to be incontinent 1 and 3 months after RARP, respectively. At both 1 and 3 months after RARP, the incidences of incontinence in patients with DO were significantly higher than in those without DO. Of several demographic and urodynamic parameters, univariate analyses identified DO and maximal urethral closure pressure （MUCP） as significant predictors of the continence status at both 1 and 3 months after RARP. Furthermore, DO and MUCP appeared to be independently associated with the continence at both I and 3 months after RARP on multivariate analysis. These findings suggest that preoperatively observed DO could be a significant predictor of urinary incontinence early after RARP; therefore, it is recommended to perform urodynamic studies for patients who are scheduled to undergo RARP in order to comprehensively evaluate their preoperative vesicourethral functions.展开更多
The interposition sural nerve graft has been attempted occasionally during radical prostatectomy for the recovery of continence and erectile function;however, nerve autograft may result in adverse events for the patie...The interposition sural nerve graft has been attempted occasionally during radical prostatectomy for the recovery of continence and erectile function;however, nerve autograft may result in adverse events for the patient. Here, we present our initial experiences using NerbridgeTM, a novel conduit for peripheral nerve regeneration, rather than utilizing sural nerve grafting, in robot-assisted laparoscopic radical prostatectomy to overcome autograft problems such as prolongation of operation time and postoperative abnormal sensation. This novel artificial conduit interposition can be technically feasible when combined with robotic surgery, and prospective randomized controlled trials with high patients-numbers and long follow-up periods are warranted.展开更多
Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,...Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,USA).Methods Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported.The primary endpoint of the study was to report the surgical setting of Hugo™RAS system to perform RARP and RARC.The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes.Results Seventeen patients underwent RARP with a transperitoneal approach,and three with an extraperitoneal approach;and one patient underwent RARC with intracorporeal ileal conduit.No intraoperative complications occurred.Median docking and console time were 12(interquartile range[IQR]7-16)min and 185(IQR 177-192)min for transperitoneal RARP,15(IQR 12-17)min and 170(IQR 162-185)min for extraperitoneal RARP.No intraoperative complications occurred.One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment(Clavien-Dindo Grade 2).In case of transperitoneal RARP,two minor complications occurred(one pelvic hematoma and one urinary tract infection;both Clavien-Dindo Grade 2).Conclusion Hugo™RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery.We showed the feasibility of RARP both intra-and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.展开更多
During radical cystectomy(RC),the neurovascular bundles are easily removed or damaged,leading to varying rates of incontinence and erectile dysfunction.The nervesparing technique was developed to preserve urinary and ...During radical cystectomy(RC),the neurovascular bundles are easily removed or damaged,leading to varying rates of incontinence and erectile dysfunction.The nervesparing technique was developed to preserve urinary and erectile function.The adoption of laparoscopic and robot-assisted technology has improved visualization and dexterity of pelvic surgeries,thus facilitate the nerve-sparing technique.Although nerve-sparing RC is technically similar with nerve-sparing radical prostatectomy,there are still some anatomical differences.There are mainly three different types of nerve-sparing techniques.Pelvic lymph node dissection(PLND)is another important factor to influence erectile function and urinary continence.Nerve-sparing laparoscopic radical cystectomy(LRC)and robot-assisted radical cystectomy(RARC)may be an optimal treatment choice in well-selected younger patients with lowvolume,organ-confined disease.We should attempt to do,whenever possible,a nerve-sparing cystectomy at least on oneside.However,due to the need of a well-refined surgical technique,nerve-sparing LRC and RARC is now being performed only by experienced urological surgeons.展开更多
The aim of this review was to systematically compare the outcomes of enhanced recovery after surgery(ERAS)with standard care(SC)after radical cystectomy.We performed a systematic search of PubMed,Ovid?Web of Science,a...The aim of this review was to systematically compare the outcomes of enhanced recovery after surgery(ERAS)with standard care(SC)after radical cystectomy.We performed a systematic search of PubMed,Ovid?Web of Science,and the Cochrane Library to identify studies published until September 2017 which involved a comparison of ERAS and SC.A meta-analysis was performed to assess the outcomes of ERAS versus SC.Sixteen studies including 8 prospective and 8 retrospective trials met the eligibility criteria.A total of 2100 participants were assigned to ERAS(1258 cases)or SC(842 cases).The time to first flatus passage[WMD=-0.95 days,95%Cl(-1.50,-0.41),P=0.0006],time until return to a regular diet[WMD=-2.15 days,95%Cl(-2.86,—1.45),P<0.00001]and the length of hospital stay[WMD=-3.75 days,95%Cl(-5.13,-2.36),P<0.00001]were significantly shorter,and the incidence of postoperative complications[OR=0.60,95%Cl(0.44,0.83),P=0.002],especially postoperative paralytic ileus[OR=0.43,95%Cl(0.30,0.62),P<0.00001]and cardiovascular complications[OR=0.28,95%Cl(0.09,0.90),P=0.03]was significantly lower in the ERAS group than those in the SC group.This meta-analysis demonstrated that ERAS was associated with a shorter time to first flatus passage,return of bowel fimction,and the length of hospital stay than SC in patients undergoing radical cystectomy,as well as a lower rate of postoperative complications,especially paralytic ileus and cardiovascular complications.展开更多
Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine th...Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months(range, 0.2–139.1 months). Thirty-day mortality was(1.4%). The 5-year recurrence-free survival, cancer-specific survival(CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease(81.4% vs. 34.9%, P < 0.001). For the 38 patients(14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis(P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor(98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age(hazard ratio, 2.045; P = 0.013) and T category(hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.展开更多
Objective:To determine the role of neutrophil-to-lymphocyte ratio(NLR)in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer.Methods:We retrospectively reviewed 84 patients...Objective:To determine the role of neutrophil-to-lymphocyte ratio(NLR)in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer.Methods:We retrospectively reviewed 84 patients undergoing radical cystectomy(RC)for UCB from January 2002 to June 2012.NLR was computed(median:5 days)prior to surgery.No patients received neoadjuvant chemotherapy.NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained,with a statistical receiver operating characteristics of 0.74.KaplaneMeier curves,multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes.Results:The median follow-up period was 30.1 months(range:3.2e161.7)owing to high recurrence rate and subsequent mortalities,compared to the median 64.7 months in patients alive at the end of study period.NLR2.7 was associated with worse survival outcomes(5-year disease-specific survival:22%vs 58%,p Z 0.017,95%CI:1.193e6.009;5-year overall survival:23%vs 60%,p Z 0.008,95%CI:1.322e6.147).Furthermore,on multivariate analyses,higher NLR was independently associated with higher recurrence rate(p Z 0.007,HR Z6.999,95%CI:1.712e28.606),higher T staging(p Z 0.021,HR Z 3.479,95%CI:1.212e9.990)and lymph node involvement(p Z 0.009,HR Z 4.534,95%CI:1.465e14.034).展开更多
Objective:To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy(MIRC)or open radical cystectomy(ORC).Methods:We identified patients with bladder cancer...Objective:To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy(MIRC)or open radical cystectomy(ORC).Methods:We identified patients with bladder cancer who underwent radical cystectomy(RC)in 13 centers of the Chinese Bladder Cancer Consortium(CBCC).Perioperative outcomes were compared between MIRC and ORC.The influence of surgical approaches on overall survival(OS)and cancer-specific survival(CSS)in the entire study group and subgroups classified according to pathologic stage or lymph node(LN)status was assessed with the log-rank test.Multivariable Cox proportional hazard models were used to evaluate the association among OS,CSS and risk factors of interest.Results:Of 2098 patients who underwent RC,1243 patients underwent MIRC(1087 laparoscopic RC and 156 robotic-assisted RC,respectively),while 855 patients underwent ORC.No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate.MIRC was associated with less estimated blood loss,more LN yield,higher rate of neobladder diversion,longer operative time,and longer length of hospital stay.There was no significant difference in OS and CSS according to surgical approaches(pZ0.653,and 0.816,respectively).Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement.Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.Conclusions:Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.展开更多
Radical cystectomy(RC)with pelvic lymph node dissection(PLND)is the standard treatment for localized muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)with recurrence or high risk of pro...Radical cystectomy(RC)with pelvic lymph node dissection(PLND)is the standard treatment for localized muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)with recurrence or high risk of progression.Also,the robotic approach to this type of surgery is well established in the literature.Our objective is to summarize in this manuscript the most relevant articles related to the robotic-assisted radical cystectomy for prostate cancer.We performed a literature review of articles describing the robotic approach to RC in patients with bladder cancer.Also,we described the procedure since the patient selection until the bladder removal.The reconstructive techniques were not included in this review.Twenty-five articles were used to divide our manuscript into key points such as preoperative patient selection and protocols,surgical technique,pathology report,oncological outcomes,complication rates,and quality of life after the procedure.Robotic-assisted radical cystectomy is feasible and safe with satisfactory oncological outcomes.The robotic approach is related to lower blood loss and fewer transfusion rates.However,when compared to open surgery,the use of this technology increases the operative time.展开更多
Background Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate-and high-risk prostate cancer.However,thi...Background Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate-and high-risk prostate cancer.However,this method is associated with symptomatic lymphocele(SLC),which is an important morbidity factor.To overcome this complication,several modifications of the technique have been developed,including the peritoneal interposition flap(PIF).We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele(LC)formation.Materials and methods Searches were performed using databases and references from included studies and previous systematic reviews.Only randomized controlled trials and nonrandomized cohorts were included.Primary outcomes were the incidence of SLC and LC formation,and safety outcomes were defined as operation time,estimated blood loss,length of hospital stay,and urinary incontinence.Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool.Pooled treatment effects were estimated using odds ratios with 95%confidence intervals(CIs)for binary endpoints.Heterogeneity was examined using Cochran's Q test and I2 statistics;p values<0.10 and I2>25%were considered significant for heterogeneity.We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity.Otherwise,the DerSimonian and Laird random-effects model was used.Results The initial search yielded 510 results.After the removal of duplicate records and application of the exclusion criterion,9 studies were fully reviewed for eligibility.Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria,comprising 2261 patients,of whom 1073(47.4%)underwent PIF.Six studies reported a significant reduction in SLC in the PIF group,and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication.The incidence of SLC and LC formation in a follow-up of≥3 months was significantly different between the PIF and no PIF group(odds ratio,0.34[95%CI,0.16–0.74;p=0.006]and 0.48[95%CI,0.31–0.74;p=0.0008]),respectively.The safety outcomes did not differ significantly between the 2 groups.Conclusions These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.展开更多
Background:Recently,an innovative tool called“proficiency score”was introduced to assess the learning curve for robot-assisted radical prostatectomy(RARP).However,the initial study only focused on patients with low-...Background:Recently,an innovative tool called“proficiency score”was introduced to assess the learning curve for robot-assisted radical prostatectomy(RARP).However,the initial study only focused on patients with low-risk prostate cancer forwhompelvic lymph node dissection(PLND)was not required.To address this issue,we aimed to validate proficiency scores of a contemporarymulticenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons.Material andmethods:Between 2010 and 2020,4 Italian institutional prostate-cancer datasets weremerged and queried for“RARP”and“high-risk prostate cancer.”High-risk prostate cancer was defined according to the most recent European Association of Urology guidelines as follows:prostate-specific antigen>20 ng/mL,International Society ofUrological Pathology≥4,and/or clinical stage(cT)≥2c on preoperative imaging.The selected cohort(n=144)included clinical cases performed by trainee surgeons(n=4)after completing their RARP learning curve(50 procedures for low-risk prostate cancer).The outcome of interest,the proficiency score,was defined as the coexistence of all the following criteria:a comparable operation time to the interquartile range of the mentor surgeon at each center,absence of any significant perioperative complications Clavien-Dindo Grade 3–5,no perioperative blood transfusions,and negative surgical margins.A logistic binary regression model was built to identify the predictors of 1-year trifecta achievement in the trainee cohort.For all statistical analyses,a 2-sided p<0.05 was considered significant.Results:A proficiency score was achieved in 42.3%patients.At univariable level,proficiency score was associated with 1-year trifecta achievement(odds ratio,8.77;95%confidence interval,2.42–31.7;p=0.001).After multivariable adjustments for age,nerve-sparing,and surgical technique,the proficiency score independently predicted 1-year trifecta achievement(odds ratio,9.58;95%confidence interval,1.83–50.1;p=0.007).Conclusions:Our findings support the use of proficiency scores in patients and require extended PLND in addition to RARP.展开更多
文摘Objective:We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures(UES)following robot-assisted radical cystectomy(RARC)and urinary diversion.Methods:Retrospective review of our RARC database from November 2005 to August 2023 at Roswell Park Comprehensive Cancer center was performed.Patients who developed UES and ultimately underwent robot-assisted uretero-enteric reimplantation(RUER)were identified.KaplaneMeier method was used to compute the cumulative incidence recurrence rate of UES after RUER.A multivariable regression model was used to identify variables associated with UES recurrence.Results:A total of 123(15%)out of 808 RARC patients developed UES,of whom 52 underwent reimplantation(45 patients underwent RUER[n=55 cases]and seven patients underwent open ureteroenteric reimplantation).The median time from RARC to UES was 4.4(interquartile range 3.0e7.0)months,and the median time between UES and RUER was 5.2(interquartile range 3.2e8.9)months.The 3-year recurrence rate after RUER is about 29%.On multivariable analysis,longer hospital stay(hazard ratio 1.37,95%confidence interval 1.16e1.61,p<0.01)was associated with recurrent UES after RUER.Conclusion:RUER for UES after RARC is feasible with durable outcomes although a notable subset of patients experienced postoperative complications and UES recurrence.
文摘Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .
基金Earlier version of this article was presented as a poster in the bladder section:invasive(MP 13-12)AUA-2021.
文摘Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).
文摘Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.
文摘Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.
文摘Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage,increased nodal involvement,similar complications outcomes,decreased overall survival,and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion.
文摘Introduction and Objective: Laparoscopic radical cystectomy (LRC) is an alternative to open approach with lower morbidity and better oncologic outcome. We aim to share our experience on laparoscopic radical cystectomy and to evaluate our morbidity and oncological outcome in our settings. Methodology: An observational study in the Douala Medico-Surgical Urology Centre on 5 patients who underwent laparoscopic cystectomy with or without lymph node dissection and external urine diversion between April 2014 to July 2016 was conducted. The overall survival rate was subsequently estimated. Results: Four men and one woman underwent laparoscopic radical cystectomy during the 5-year study period with a mean age of 54.5-year-old. Three patients were submitted to ileal conduits, one to neobladders, and one patient to uretero-cutaneostomies. The mean operative time was 300 ± 17 minutes and the mean length of hospital stay was 9 ± 3 days. Three patients had minor complications according to Clavien and Dindon Classification treated conservatively without need for further operation. Four patients had transitional cell carcinoma and one Squamous cell carcinoma types. Everyone had negative resection margin while only two had negative lymph node. The median survival years in our study was 2.5 years, the overall survival rates at 2 years were 60%, 40% at 3 years and 20 at 5years. 2 patients die after one year due to renal failure and intercurrent disease. Conclusion: Laparoscopic radical cystectomy carried lower morbidity and cancerological outcome compare to open surgery making it a good alternative for bladder oncologic surgery.
文摘Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.
文摘Robotic-assisted radical prostatectomy(RARP)is the current standard of care with long term cure in organ-confined disease.The introduction of nerve-sparing(NS)to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes.This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes,the neurovascular bundle(NVB),various NS techniques and postoperative functional outcomes.A non-systematic review was done using PubMed,Embase and Medline databases to retrieve and analyse articles in English,with following keywords“prostate cancer”,“robotic radical prostatectomy”,“nerve-sparing”.The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies.The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other.Variables such as preoperative risk assessments,baseline potency,surgical anatomy of individual patients and surgeons’expertise play a major role in the outcomes.A tailored approach for each patient is required for applying the NS approach during RARP.
文摘Several recent studies have reported the involvement of bladder dysfunction in the delayed recovery of urinary continence following radical prostatectomy （RP）. The objective of this study was to investigate the significance of detrusor overactivity （DO） as a predictor of the early continence status following robot-assisted RP （RARP）. This study included 84 consecutive patients with prostate cancer undergoing RARP. Urodynamic studies, including filling cystometry, pressure flow study, electromyogram of the external urethral sphincter and urethral pressure profile, were performed in these patients before surgery. Urinary continence was defined as the use of either no or one pad per day as a precaution only. DO was preoperatively observed in 30 patients （35.7%）, and 55 （65.5%） and 34 （40.5%） were judged to be incontinent 1 and 3 months after RARP, respectively. At both 1 and 3 months after RARP, the incidences of incontinence in patients with DO were significantly higher than in those without DO. Of several demographic and urodynamic parameters, univariate analyses identified DO and maximal urethral closure pressure （MUCP） as significant predictors of the continence status at both 1 and 3 months after RARP. Furthermore, DO and MUCP appeared to be independently associated with the continence at both I and 3 months after RARP on multivariate analysis. These findings suggest that preoperatively observed DO could be a significant predictor of urinary incontinence early after RARP; therefore, it is recommended to perform urodynamic studies for patients who are scheduled to undergo RARP in order to comprehensively evaluate their preoperative vesicourethral functions.
文摘The interposition sural nerve graft has been attempted occasionally during radical prostatectomy for the recovery of continence and erectile function;however, nerve autograft may result in adverse events for the patient. Here, we present our initial experiences using NerbridgeTM, a novel conduit for peripheral nerve regeneration, rather than utilizing sural nerve grafting, in robot-assisted laparoscopic radical prostatectomy to overcome autograft problems such as prolongation of operation time and postoperative abnormal sensation. This novel artificial conduit interposition can be technically feasible when combined with robotic surgery, and prospective randomized controlled trials with high patients-numbers and long follow-up periods are warranted.
文摘Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,USA).Methods Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported.The primary endpoint of the study was to report the surgical setting of Hugo™RAS system to perform RARP and RARC.The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes.Results Seventeen patients underwent RARP with a transperitoneal approach,and three with an extraperitoneal approach;and one patient underwent RARC with intracorporeal ileal conduit.No intraoperative complications occurred.Median docking and console time were 12(interquartile range[IQR]7-16)min and 185(IQR 177-192)min for transperitoneal RARP,15(IQR 12-17)min and 170(IQR 162-185)min for extraperitoneal RARP.No intraoperative complications occurred.One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment(Clavien-Dindo Grade 2).In case of transperitoneal RARP,two minor complications occurred(one pelvic hematoma and one urinary tract infection;both Clavien-Dindo Grade 2).Conclusion Hugo™RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery.We showed the feasibility of RARP both intra-and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.
基金supported by Yat-sen Clinical Trail Project(No.200501).
文摘During radical cystectomy(RC),the neurovascular bundles are easily removed or damaged,leading to varying rates of incontinence and erectile dysfunction.The nervesparing technique was developed to preserve urinary and erectile function.The adoption of laparoscopic and robot-assisted technology has improved visualization and dexterity of pelvic surgeries,thus facilitate the nerve-sparing technique.Although nerve-sparing RC is technically similar with nerve-sparing radical prostatectomy,there are still some anatomical differences.There are mainly three different types of nerve-sparing techniques.Pelvic lymph node dissection(PLND)is another important factor to influence erectile function and urinary continence.Nerve-sparing laparoscopic radical cystectomy(LRC)and robot-assisted radical cystectomy(RARC)may be an optimal treatment choice in well-selected younger patients with lowvolume,organ-confined disease.We should attempt to do,whenever possible,a nerve-sparing cystectomy at least on oneside.However,due to the need of a well-refined surgical technique,nerve-sparing LRC and RARC is now being performed only by experienced urological surgeons.
基金grants from the Natural Science Foundation of Hubei Province,China(No 2016CFB619)Clinical Research Physician Program of Tongji Medical College,HUST(No.5001540017).
文摘The aim of this review was to systematically compare the outcomes of enhanced recovery after surgery(ERAS)with standard care(SC)after radical cystectomy.We performed a systematic search of PubMed,Ovid?Web of Science,and the Cochrane Library to identify studies published until September 2017 which involved a comparison of ERAS and SC.A meta-analysis was performed to assess the outcomes of ERAS versus SC.Sixteen studies including 8 prospective and 8 retrospective trials met the eligibility criteria.A total of 2100 participants were assigned to ERAS(1258 cases)or SC(842 cases).The time to first flatus passage[WMD=-0.95 days,95%Cl(-1.50,-0.41),P=0.0006],time until return to a regular diet[WMD=-2.15 days,95%Cl(-2.86,—1.45),P<0.00001]and the length of hospital stay[WMD=-3.75 days,95%Cl(-5.13,-2.36),P<0.00001]were significantly shorter,and the incidence of postoperative complications[OR=0.60,95%Cl(0.44,0.83),P=0.002],especially postoperative paralytic ileus[OR=0.43,95%Cl(0.30,0.62),P<0.00001]and cardiovascular complications[OR=0.28,95%Cl(0.09,0.90),P=0.03]was significantly lower in the ERAS group than those in the SC group.This meta-analysis demonstrated that ERAS was associated with a shorter time to first flatus passage,return of bowel fimction,and the length of hospital stay than SC in patients undergoing radical cystectomy,as well as a lower rate of postoperative complications,especially paralytic ileus and cardiovascular complications.
基金supported by grants from the Natural Science Foundation of China (No. 81272810)the Natural Science Foundation of Guangdong Province, China (No. S2012010009466)
文摘Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months(range, 0.2–139.1 months). Thirty-day mortality was(1.4%). The 5-year recurrence-free survival, cancer-specific survival(CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease(81.4% vs. 34.9%, P < 0.001). For the 38 patients(14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis(P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor(98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age(hazard ratio, 2.045; P = 0.013) and T category(hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.
文摘Objective:To determine the role of neutrophil-to-lymphocyte ratio(NLR)in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer.Methods:We retrospectively reviewed 84 patients undergoing radical cystectomy(RC)for UCB from January 2002 to June 2012.NLR was computed(median:5 days)prior to surgery.No patients received neoadjuvant chemotherapy.NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained,with a statistical receiver operating characteristics of 0.74.KaplaneMeier curves,multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes.Results:The median follow-up period was 30.1 months(range:3.2e161.7)owing to high recurrence rate and subsequent mortalities,compared to the median 64.7 months in patients alive at the end of study period.NLR2.7 was associated with worse survival outcomes(5-year disease-specific survival:22%vs 58%,p Z 0.017,95%CI:1.193e6.009;5-year overall survival:23%vs 60%,p Z 0.008,95%CI:1.322e6.147).Furthermore,on multivariate analyses,higher NLR was independently associated with higher recurrence rate(p Z 0.007,HR Z6.999,95%CI:1.712e28.606),higher T staging(p Z 0.021,HR Z 3.479,95%CI:1.212e9.990)and lymph node involvement(p Z 0.009,HR Z 4.534,95%CI:1.465e14.034).
基金supported by the National Natural Science Foundation of China(Grant No.81825016,81772719,81772728,81572514)the Key Areas Research and Development Program of Guangdong(Grant No.2018B010109006)Medical Scientific Research Foundation of Guangdong Province(Grant No.A2018388).
文摘Objective:To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy(MIRC)or open radical cystectomy(ORC).Methods:We identified patients with bladder cancer who underwent radical cystectomy(RC)in 13 centers of the Chinese Bladder Cancer Consortium(CBCC).Perioperative outcomes were compared between MIRC and ORC.The influence of surgical approaches on overall survival(OS)and cancer-specific survival(CSS)in the entire study group and subgroups classified according to pathologic stage or lymph node(LN)status was assessed with the log-rank test.Multivariable Cox proportional hazard models were used to evaluate the association among OS,CSS and risk factors of interest.Results:Of 2098 patients who underwent RC,1243 patients underwent MIRC(1087 laparoscopic RC and 156 robotic-assisted RC,respectively),while 855 patients underwent ORC.No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate.MIRC was associated with less estimated blood loss,more LN yield,higher rate of neobladder diversion,longer operative time,and longer length of hospital stay.There was no significant difference in OS and CSS according to surgical approaches(pZ0.653,and 0.816,respectively).Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement.Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.Conclusions:Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.
文摘Radical cystectomy(RC)with pelvic lymph node dissection(PLND)is the standard treatment for localized muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)with recurrence or high risk of progression.Also,the robotic approach to this type of surgery is well established in the literature.Our objective is to summarize in this manuscript the most relevant articles related to the robotic-assisted radical cystectomy for prostate cancer.We performed a literature review of articles describing the robotic approach to RC in patients with bladder cancer.Also,we described the procedure since the patient selection until the bladder removal.The reconstructive techniques were not included in this review.Twenty-five articles were used to divide our manuscript into key points such as preoperative patient selection and protocols,surgical technique,pathology report,oncological outcomes,complication rates,and quality of life after the procedure.Robotic-assisted radical cystectomy is feasible and safe with satisfactory oncological outcomes.The robotic approach is related to lower blood loss and fewer transfusion rates.However,when compared to open surgery,the use of this technology increases the operative time.
文摘Background Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate-and high-risk prostate cancer.However,this method is associated with symptomatic lymphocele(SLC),which is an important morbidity factor.To overcome this complication,several modifications of the technique have been developed,including the peritoneal interposition flap(PIF).We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele(LC)formation.Materials and methods Searches were performed using databases and references from included studies and previous systematic reviews.Only randomized controlled trials and nonrandomized cohorts were included.Primary outcomes were the incidence of SLC and LC formation,and safety outcomes were defined as operation time,estimated blood loss,length of hospital stay,and urinary incontinence.Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool.Pooled treatment effects were estimated using odds ratios with 95%confidence intervals(CIs)for binary endpoints.Heterogeneity was examined using Cochran's Q test and I2 statistics;p values<0.10 and I2>25%were considered significant for heterogeneity.We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity.Otherwise,the DerSimonian and Laird random-effects model was used.Results The initial search yielded 510 results.After the removal of duplicate records and application of the exclusion criterion,9 studies were fully reviewed for eligibility.Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria,comprising 2261 patients,of whom 1073(47.4%)underwent PIF.Six studies reported a significant reduction in SLC in the PIF group,and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication.The incidence of SLC and LC formation in a follow-up of≥3 months was significantly different between the PIF and no PIF group(odds ratio,0.34[95%CI,0.16–0.74;p=0.006]and 0.48[95%CI,0.31–0.74;p=0.0008]),respectively.The safety outcomes did not differ significantly between the 2 groups.Conclusions These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.
文摘Background:Recently,an innovative tool called“proficiency score”was introduced to assess the learning curve for robot-assisted radical prostatectomy(RARP).However,the initial study only focused on patients with low-risk prostate cancer forwhompelvic lymph node dissection(PLND)was not required.To address this issue,we aimed to validate proficiency scores of a contemporarymulticenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons.Material andmethods:Between 2010 and 2020,4 Italian institutional prostate-cancer datasets weremerged and queried for“RARP”and“high-risk prostate cancer.”High-risk prostate cancer was defined according to the most recent European Association of Urology guidelines as follows:prostate-specific antigen>20 ng/mL,International Society ofUrological Pathology≥4,and/or clinical stage(cT)≥2c on preoperative imaging.The selected cohort(n=144)included clinical cases performed by trainee surgeons(n=4)after completing their RARP learning curve(50 procedures for low-risk prostate cancer).The outcome of interest,the proficiency score,was defined as the coexistence of all the following criteria:a comparable operation time to the interquartile range of the mentor surgeon at each center,absence of any significant perioperative complications Clavien-Dindo Grade 3–5,no perioperative blood transfusions,and negative surgical margins.A logistic binary regression model was built to identify the predictors of 1-year trifecta achievement in the trainee cohort.For all statistical analyses,a 2-sided p<0.05 was considered significant.Results:A proficiency score was achieved in 42.3%patients.At univariable level,proficiency score was associated with 1-year trifecta achievement(odds ratio,8.77;95%confidence interval,2.42–31.7;p=0.001).After multivariable adjustments for age,nerve-sparing,and surgical technique,the proficiency score independently predicted 1-year trifecta achievement(odds ratio,9.58;95%confidence interval,1.83–50.1;p=0.007).Conclusions:Our findings support the use of proficiency scores in patients and require extended PLND in addition to RARP.
