達文西機器人輔助根除性膀胱切除術；單一中心經驗
林宜佳1,2，何肇晏1，朱懿柏1，葉志胤1，吳子翔1，蔡德甫1,2, 陳宏恩1，仇光宇1,2，鄭以弘1，莊光達1,2，葉忠信1,2，邱文祥1,2，黃一勝1,2
新光吳火獅紀念醫院 泌尿科1 輔仁大學醫學系2
Robotic-assisted radical cystectomy: experience of a single institution
Yi-Chia Lin1,2, Chao-Yen Ho1, Yi-Bo Chu1, Chih-Yin Yeh1, Tzu-Shiang Wu1, Te-Fu Tsai1,2, Hung-En Chen1, Kuang-Yu Chou1,2, Yi-Hong Cheng1, Gaung-Dar Juang1,2, Chung-Hsin Yeh1,2, Allen WS Chiu1, Thomas IS Hwang1,2
Department of Urology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan;
School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
Purpose: Robotic-Assisted radical cystectomy (RARC) has become a viable option for patients with bladder cancer. We report our experience on RARC in a single institution.
Materials and Methods: From Aug, 2016 to Feb, 2019, 14 RARC were performed in our hospital. Six of them were male and 8 were female. All the patients were confirmed with invasive urothelial carcinoma (UC) except one with invasive melanoma. The peri-operative parameters and post-operative outcomes were collected retrospectively with medical record review.
Results: The median age was 62 (52-84) years old. Among the 13 bladder UC patients, 3 had radiation and 2 had neoadjuvant chemotherapy. The patient with melanoma had both radiation and chemotherapy before operation. The median operation time was 300 (140-540) minutes and blood loss was 300 (50-700) ml. Three of the patients had a concomitant nephroureterectomy for their upper tract UC. The median lymph node yields is this series was 16 (6-30) and 2 of them were identified to have positive lymph node metastasis. One intra-operative complication was found (7%) and median length of stay was 17.5 (12-36) days. Post-operative complications were found in 4 patients (29%), 3 of them required surgical or radiological interventions. Urological complications were found in 3 of the patients and 1 had non-urological complication. One in-hospital mortality was identified due to sepsis after adjuvant chemotherapy immediate after surgery. The 30-day readmission rate was 7%. Three patients experienced recurrence or metastasis and the survival rate within a median follow-up of 13 (1-48) months was 70%.
Conclusions: RARC is a feasible procedure for invasive bladder cancer. The complication rate is acceptable and post-operative results are promising. Further study with larger case volume is mandatory.