台北慈濟醫院微創膀胱根除手術的經驗
周奕儒1、蔡曜州1
Outcome of minimally invasive radical cystectomy in Taipei Tzu Chi Hospital
Yi-Ju Chou1, Yao-Chou Tsai1
Purpose:
Minimally invasive radical cystectomy has been proved to have similar oncologic outcome to open radical cystectomy. It has the benefit of faster recovery and fewer blood loss but at the cost of increased operation time and expenditure. The outcome of minimally invasive radical cystectomy in Taipei Tzu Chi Hospital has not been reviewed extensively before. We aimed to evaluate the outcome of laparoscopic and robot-assisted radical cystectomy and compared the results with relative literatures.
Materials and Methods:
From 2006/01/01 to 2022/09/01, we searched the electronic medical database with keywords of malignant neoplasm of bladder and cystectomy. The medical records were reviewed and those who didn’t receive minimally invasive approach as treatment were excluded. The baseline characteristics, perioperative outcome, complication rate, pathologic outcome and oncologic outcome were extracted from the records. Major complication was defined as Clavien-Dindo grade >2. Kaplan-Meier survival curve was used to evaluate the survival of study cohort. Literature search was performed with keyword of minimally invasive radical cystectomy to identify relative studies for comparison.
Results:
Thirty-five patients met our inclusion criteria and 21 patients (60%) received robot assisted radical cystectomy. Median age was 65 (IQR: 62–72), follow up time was 22.8 months (IQR: 6.8–46.2) and 45.7% of patients received neoadjuvant chemotherapy. Median operation time was 552 minutes (IQR: 491.3–600), blood loss was 430ml (IQR: 335–775), time to diet was 3 days (IQR: 3–4.75) and length of stay was 16 days (IQR: 14–18). All urine diversions were performed extracorporeally and 48.6% of patients have Studer neobladder as diversion method. Median lymph nodes yield was 12 (IQR: 7–17.5). The major complication rate at 30 days and 90 days were 20 and 25.7%, respectively. For oncologic outcome, the 3-year disease-free survival, cancer-specific survival and overall survival were 72.7%, 82.9% and 74.4%, respectively.
Conclusion:
Compared with current literatures, the outcome of minimally invasive radical cystectomy in Taipei Tzu Chi Hospital demonstrated longer operation time, longer length of stay, fewer lymph nodes yield and slightly lower survival rate. Blood loss and complication rate were comparable to others’ results.