機器人輔助部分膀胱切除術的結果：對惡性和良性病理學患者進行的圍手術期參數和生存分析的回顧性研究

林寬宇¹、邵翊紘²、林柏宏^2,3,4、虞凱傑²、馮思中²、吳俊德²

¹林口長庚紀念醫院 教學部; ²林口長庚紀念醫院 外科部 泌尿科系; ³長庚大學 醫學院 臨床醫學研究所; ⁴長庚大學 醫學院 醫學系

Outcomes of Robot-Assisted Partial Cystectomy: A Retrospective Study on Perioperative Parameters and Survival Analysis in Patients with Malignant and Benign Pathology

Kuan-Yu Lin¹、I-Hung Shao²、Po-Hung Lin^2,3,4、Kai-Jie Yu²、See-Tong Pang²、Chun-Te Wu²

¹Department of Medical Education, LinKou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; ²Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; ³Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; ⁴School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

Purpose: Robot-assisted partial cystectomy (RAPC) has emerged as a promising surgical approach for various urological malignancies and benign conditions. However, reports detailing perioperative outcomes and follow-up data of RAPC remain limited. This study aims to present our institution's experience with RAPC across a spectrum of urological conditions, focusing on perioperative outcomes and follow-up data.

Materials and Methods: A retrospective analysis was conducted on patients who underwent RAPC at our institution from 2009 to 2023. Data collection included patients' clinical profiles, perioperative parameters, postoperative course, as well as recurrence and survival outcomes during follow-up. Survival was calculated utilizing the Kaplan-Meier method.

Results: We included 30 patients with lesions located at various sites, with the bladder dome being the most common. Pathology results revealed a diverse range of findings, including urachal adenocarcinoma, urothelial carcinoma, and bladder diverticulum, among others. The median duration of surgery was 260 minutes, with a median blood loss of 40 milliliters. Patients had a median postoperative hospital stay of 5 days. Overall complications were observed in 5 patients (17%). There was no significant difference in perioperative outcomes between benign and malignant lesions. Disease progression, including local recurrence and distant metastasis, was documented in 9 patients (30%). There was no significant difference in the disease progression rate between urachal and non-urachal malignant lesions, with 5 patients (55.6%) and 4 patients (50%) respectively (p-value = 1). For overall survival, a significant difference was observed between the localized disease group and the advanced disease group (median survival not reached in the localized group, median survival of 56 months in the advanced group, 95% CI 0.000-121.242, log-rank test p = 0.019). Similarly, in terms of progression-free survival, there was a significant difference between the two groups (median survival not reached in the localized group, median survival of 8 months in the advanced group, 95% CI 0.000-16.765, log-rank test p = 0.013).

Conclusion: High recurrence rate was noted in urachal adenocarcinoma, comparable to current understanding of the pathology, but no significant difference was found comparing to non-urachal malignant lesion. Low progression free survival was noted in advanced group, but adequate overall survival was noted. Our findings underscore the safety and efficacy of RAPC across diverse urological conditions, highlighting acceptable perioperative outcomes and promising follow-up results.