Int J Urol:机器人辅助根治性膀胱切除术后并发症的预测因素

2022-03-10 AlexYang MedSci原创

评价了机器人辅助根治性膀胱切除术后的并发症,并揭示了是否存在术后并发症的预测因素。

机器人辅助根治性膀胱切除(RARC)的引入是为了减少开放性根治性膀胱切除术(ORC)的围手术期并发症。此前一些研究报告称,与ORC相比,RARC的围手术期结果良好。此外,最近的研究表明,RARC的肿瘤学结果和复发模式与ORC相似。这表明RARC是一种具有潜力的机器人手术技术。与此同时,解决与RC相关的发病率和死亡率问题,对于术前咨询、未来的治疗计划以及识别可改变的风险因素以降低发病率和死亡率仍然十分重要

近日,来自韩国首尔国立大学Bundang医院等单位的研究人员在膀胱癌患者中评价了机器人辅助根治性膀胱切除术后的并发症,并揭示了是否存在术后并发症的预测因素。相关研究结果发表在《International Journal of Urology》期刊上。

研究人员回顾了2007年4月至2019年5月期间在13个三级转诊中心前瞻性地收集的730份机器人辅助根治性膀胱切除术患者的医疗记录。他们通过术后并发症情况(有并发症vs无并发症)比较了两组患者的围手术期结果。然后评估了组间无复发生存率(RFS)、癌症特异性生存率(CSS)和总生存率(OS),并进行回归分析来确定与术后并发症相关的因素。

结果显示,任意总体并发症和高等级并发症(Clavien-Dindo等级≥3)的发生率分别为57.8%和21.1%。并发症组患者的糖尿病(P = 0.048)、慢性肾脏病(P = 0.011)、血脂异常(P < 0.001)比例明显较高,以及手术时间显著更长(P = 0.001)、估计失血量明显较多(P = 0.001)和术中输液量显著增加(P < 0.001)。癌症特异性生存率有明显差异(对数秩P = 0.038,癌症特异性生存率中位数:两组均未达到)。血脂异常(优势比2.59,P = 0.002)和术中输液量(优势比1.0002,P = 0.040)与高等级术后并发症明显相关。糖尿病(优势比1.97,P = 0.028)、慢性肾脏病(优势比.89,P = 0.046)、血脂异常(优势比5.94,P = 0.007)和术中输液量(优势比1.0002,P = 0.009)与任意术后并发症明显相关。

RARC术后的(a)RFS、(b) CSS和 (c) OS

综上所述,患有糖尿病、慢性肾脏病、血脂异常或术中输液量相对较大的患者更有可能出现术后并发症。有术后并发症的患者的癌症特异性存活率可能更低

原始出处:

Hwanik Kim , Byong Chang Jeong , Sangchul Lee et al. Predicting factor analysis of postoperative complications after robot-assisted radical cystectomy: Multicenter KORARC database study. Int J Urol. Feb 2022

 

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    2022-12-17 丁鹏鹏
  4. 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createdTime=Sat Mar 12 14:03:25 CST 2022, time=2022-03-12, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1877562, encodeId=a8ad18e7562d7, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu Jan 19 03:03:25 CST 2023, time=2023-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1973308, encodeId=1bff19e330831, content=<a href='/topic/show?id=75a16223199' target=_blank style='color:#2F92EE;'>#根治性膀胱切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62231, encryptionId=75a16223199, topicName=根治性膀胱切除术)], attachment=null, authenticateStatus=null, createdAvatar=, 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encodeId=798f158335970, content=<a href='/topic/show?id=f6e1611840d' target=_blank style='color:#2F92EE;'>#机器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61184, encryptionId=f6e1611840d, topicName=机器)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13dc16973127, createdName=ms6279672939590805, createdTime=Sat Mar 12 14:03:25 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586282, encodeId=d86b15862823d, content=<a href='/topic/show?id=38f8622191b' target=_blank style='color:#2F92EE;'>#根治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62219, encryptionId=38f8622191b, topicName=根治)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26d917348678, createdName=jeanqiuqiu, createdTime=Sat Mar 12 14:03:25 CST 2022, time=2022-03-12, status=1, ipAttribution=)]
    2022-03-12 xue8602
  6. 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  7. 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  8. 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  9. 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createdTime=Sat Mar 12 14:03:25 CST 2022, time=2022-03-12, status=1, ipAttribution=)]
    2022-03-12 jeanqiuqiu

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