OBJECTIVE
Regional pelvic lymphadenectomy (PLND) combined with radical cystectomy is the standard curative treatment for non-metastatic high-risk non-muscle-invasive or muscle-invasive bladder cancer.
The most common method of surgery is an open radical cystectomy (ORC). But there are serious risks involved with this surgical procedure. It has been demonstrated that using robotic surgery, one of the minimally invasive surgical procedures, can reduce surgical morbidity and speed up recovery. In this study, we used matched pair analysis to examine the postoperative problems and outcomes of patients who underwent RARC and ORC for bladder cancer in our clinic.
METHODS
After getting permission from the Institutional Review Board for Retrospective Studies, data from radical
cystectomy patients were collected in our clinic between January 2021 and February 2023. Twenty patients who underwent RARC and forty patients who underwent ORC were matched at a ratio of 1:2 for age (+/- 2 years), gender, clinical TNM stage, and urinary diversion (ileal conduit or orthotopic neobladder) during the same period. Comparisons were made between perioperative and postoperative outcomes and complications.
RESULTS
In terms of preoperative data, there was no difference between the two groups. In the RARC group, the
operative time was significantly longer (307.5 versus 391.7 minutes; P=.0001). RARC patients had significantly lower EBL (P=.001) and needed less intraoperative blood transfusions (P=.023). In ORC, ICU stays were significantly longer (P =.047). The rates of mild Clavien complications after 90 days were comparable in all groups. Open surgery had a significantly higher incidence of major (clavien 3-5) problems (P=.042). For RARC and ORC, the 90-day mortality rate was 7.5% and 0%, respectively. There was no difference between the two groups in terms of pathological outcomes.
CONCLUSION
Our initial experience with RARC has demonstrated that it is safe and practical, with comparable pathology outcomes, perioperative blood loss avoidance, and 90-day mortality improvements, even when compared to higher ORC experience.
Amaç: Biz bu çalışmada mesane kanserinin kas invazyonunu preoperatif tahmin etmede “Vesical Imaging Reporting and Data System” (VI-RADS) skorlama sisteminin doğruluğunu araştırmayı amaçladık.Gereç ve Yöntemler: Ağustos 2020 ile Mart 2022 arasında preoperatif mp-MRG çekilen mesane kanserli hastalar çalışmaya dahil edildi. Mesane tümörleri deneyimli bir üroradyolog tarafından VI-RADS skorlama sistemi ile değerlendirildi. VI-RADS skoru, kas invazyonunu belirlemek için postoperatif patoloji ile karşılaştırıldı. VI-RADS ≥3 ve VI-RADS ≥4 kesme noktası için duyarlılık, özgüllük, poizitif öngörü değeri (PÖD), negatif öngörü değeri (NÖD) ve doğruluk hesaplandı.Bulgular: Toplam 102 hastanın dördünde bening patoloji (Üç hastada sistitis sistika, bir hastada nefrojenik adenom) saptandı. Çalışmaya kalan 98 hasta dahil edildi. 38 hastada kasa invaziv ve 60 hastada ise kasa invaziv olmayan mesane kanseri saptandı. Kas invazyonunu belirlemede VI-RADS skorunun eşik değeri 3 olarak alındığında duyarlılık, özgüllük, PÖD, NÖD ve doğruluğu sırasıyla %92, %85, %94, %80 ve %88 olarak hesaplandı. Bununla beraber VI-RADS skorunun eşik değeri 4 olarak alındığında duyarlılık, özgüllük, PÖD, NÖD değeri ve doğruluğu sırasıyla %82, %95, %89, %91 ve %90 saptandı.Sonuç: Sonuç olarak mesane mp-MRG, VI-RADS kriterleri eşliğinde VI-RADS eşik değer 3 veya 4’ün kas invaziv mesane kanserinin saptanmasında başarılı bir yöntem olup tanısal performansı artırabilir.
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