Is robotic radical cystectomy an appropriate treatment for bladder cancer? Short-term oncologic and clinical follow-up in 50 consecutive patients.

摘要

OBJECTIVES: Recent case series have now been reported for robotic cystectomy. Despite the novelty of these approaches, few reports have been published on the oncologic and clinical outcomes, even in the short term. We report the oncologic and short-term clinical outcomes of 50 patients who underwent robotic-assisted radical cystectomy. METHODS: A total of 50 patients underwent robotic-assisted laparoscopic radical cystectomy and extracorporeal urinary diversion for bladder cancer. The outcome measures included the pathologic outcomes, complication rate, timing of adjuvant chemotherapy, disease recurrence, and overall and disease-specific survival. RESULTS: Robotic cystectomy was performed in 40 men and 10 women at a mean age of 63.6 years. Of the 50 patients, 66% had Stage pT2 or less, 14% had pT3 disease, and 20% Stage N+ disease. No patient had positive surgical margins. The mean number of lymph nodes removed was 19 (range 8-37). The mean clinical follow-up was 13.2 months. Seven patients had evidence of recurrent disease. Three patients died of advanced urothelial carcinoma, and two died of other causes. Longer term complications included stomal hernia in 2 and partial ureteral obstruction in 1. Eleven patients underwent adjuvant chemotherapy for Stage pT3 disease and N+ disease at a mean of 7.2 weeks postoperatively. CONCLUSIONS: The clinical and oncologic follow-up of patients undergoing robotic radical cystectomy appears to be favorable in the short term. As our follow-up increases, we should expect to continue to truly define the long-term clinical appropriateness and oncologic success of this procedure.