膀胱癌病患接受機械手臂輔助與傳統腹腔鏡根除性膀胱切除手術之住院預後比較: 國家級住院病患資料庫取樣研究

樊樂威¹、李允仁¹、吳城慕²、莊凱棣³、李威昌¹、劉忠一¹、張英勛¹

1.新北市立土城醫院泌尿科; 2.國立陽明交通大學醫學生物技術暨檢驗學系; 3.新北市立土城醫院整形外科

Inpatient Outcomes of Patients Undergoing Robot-Assisted versus Laparoscopic Radical Cystectomy for Bladder Cancer: A National Inpatient Sample Database Study

Le-Wei Fan ¹, Yun-Ren Li ¹, Cheng-Mu Wu ², Kai-Ti Chuang ³, Wei-Chang Li ¹, Chung-Yi Liu ¹ and Ying-Hsu Chang ¹

1 Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University; 2 Department of Biotechnology and Laboratory Science in Medicine, National Tang Ming

Chiao Tung University; 3 Division of Plastic and Reconstructive Surgery, Department of Surgery, New Taipei Municipal

TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University

Background: Bladder cancer is a common urinary tract malignancy. Minimally invasive radical cystectomy has shown oncological outcomes comparable to the conventional open surgery and with advantages over the open procedure. However, outcomes of the two main minimally invasive procedures, robot-assisted and pure laparoscopic, have yet to be compared. This study aimed to compare in-hospital outcomes between these two techniques performed for patients with bladder cancer.

Methods: This population-based, retrospective study included hospitalized patients aged ≥ 50 years with a primary diagnosis of bladder cancer who underwent robot-assisted or pure laparoscopic radical cystectomy. All patient data were extracted from the US National Inpatient Sample (NIS) database 2008-2018 and were analyzed retrospectively. Primary outcomes were in-hospital mortality, prolonged length of stay (LOS), and postoperative complications.

Results: The data of 3284 inpatients (representing 16,288 US inpatients) were analyzed. After adjusting for confounders, multivariable analysis revealed that patients who underwent robot-assisted radical cystectomy had a significantly lower risk of in-hospital mortality (adjusted OR [aOR], 0.50, 95% CI: 0.28-0.90) and prolonged LOS (aOR, 0.63, 95% CI: 0.49-0.80) than those undergoing pure laparoscopic cystectomy. Patients who underwent robot-assisted radical cystectomy had a lower risk of postoperative complications (aOR, 0.69, 95% CI: 0.54-0.88), including bleeding (aOR, 0.73, 95% CI: 0.54-0.99), pneumonia (aOR, 0.49, 95% CI: 0.28-0.86), infection (aOR, 0.55, 95% CI: 0.36-0.85), wound complications (aOR, 0.33, 95% CI: 0.20-0.54), and sepsis (aOR, 0.49, 95% CI: 0.34-0.69) compared to those receiving pure laparoscopic radical cystectomy.

Conclusions: Patients with bladder cancer, robot-assisted radical cystectomy is associated with a reduced risk of unfavorable short-term outcomes, including in-hospital mortality, prolonged LOS, and postoperative complications compared to pure laparoscopic radical cystectomy.