Is Robot-assisted Radical Nephroureterectomy with Bladder Cuff Excision Superior to Pure Laparoscopic Approach in The Treatment of Upper Urinary Tract Urothelial Carcinoma?
黃裕賓1、黃逸修1,2、鍾孝仁1,2、戴盟哲1、黃子豪1,2、魏子鈞1,2、范玉華1,2、林志杰1,2、林子平1,2、郭俊逸1,2、盧星華1,2、張延驊1,2、林登龍1,2、黃志賢1,2
臺北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
機械手臂輔助腎臟輸尿管併膀胱袖口切除手術對上泌尿道上皮癌有優於傳統腹腔鏡手術嗎？
Yu-Pin Huang1, Eric Y.H. Huang1,2, Hsiao-Jen Chung1,2, Meng-Che Tai1, Tzu-Hao Huang1,2,Tzu-Chun Wei1,2, Yu-Hua Fan1,2, Chi-Cheh Lin1,2, Tzu-Ping Lin1,2, Junne-Yih Kuo1,2, Shing-Hwa Lu1,2,Yen-Hwa Chang1,2, Alex T.L. Lin1,2,William J.S. Huang1,2
Department of Urology, Taipei Veterans General Hospital1
Department of Urology, School of Medicine and
Shu-Tien Urological Institute, National Yang-Ming University2, Taipei, Taiwan
Purpose:
Laparoscopic nephroureterectomy has been introduced to the treatment of upper urinary tract urothelial carcinoma for a long time, which could provide better cosmesis and comparable oncological outcomes to its open counterpart. Robotic approach was applied to such clinical scenario recently. However, there are few reports comparing laparoscopic and robotic approaches. We presented our experiences of robot-assisted (RANU) versus pure laparoscopic (LNU) radical nephroureterectomy with bladder cuff excision.
Materials and Methods:
A retrospective review was performed for patients who underwent LNU or RANU from March 2012 to October 2017. Patients were matched for age (± 3 years) and gender between the two treatment arm. The perioperative and oncological outcomes were compared.
Results:
A matched cohort of 174 patients who underwent RANU (n = 87) or LNU (n = 87) were compared. Each group consisted of 47 men and 40 women. There were no significant differences between the 2 groups with respect to BMI (p = 0.63) and tumor location. The mean follow-up duration was 24.8 months in RANU group and 24.5 months in LNU group. No significant differences were noted regarding the total operative and nephroureterectomy time (335.8 vs 318.3 minutes, p = 0.15; 137.8 vs 147.4 minutes, p = 0.28), median post-operative hospital stay (8 vs 9 days, p = 0.50), median catheter time (5 vs 6 days, p = 0.13), positive surgical margin rate (4.6% vs 8%, p = 0.35) and peri-operative complications.
However, the median estimated blood loss (EBL) was higher in the LNU cohort (150 vs 30 mL, p < 0.001). There were no significant differences with respect to bladder recurrence, distant metastasis, cancer-specific death, and overall survival.
Conclusions:
LNU and RANU had similar perioperative and oncological outcomes in our experiences. However, higher EBL was observed in the LNU cohort.