Comparison of Perioperative Outcomes Between Open and Robotic Radical Cystectomy: A Population-Based Analysis

被引:19
|
作者
Nazzani, Sebastiano [1 ,2 ,3 ,4 ]
Mazzone, Elio [1 ,2 ,3 ,5 ,6 ]
Preisser, Felix [1 ,2 ,3 ,7 ]
Bandini, Marco [1 ,2 ,3 ,5 ]
Tian, Zhe [1 ]
Marchioni, Michele [8 ]
Ratti, Dario [4 ]
Motta, Gloria [4 ]
Zorn, Kevin C. [2 ,3 ]
Briganti, Alberto [5 ,6 ]
Shariat, Shahrokh F. [9 ]
Montanari, Emanuele [10 ]
Carmignani, Luca [4 ]
Karakiewicz, Pierre I. [1 ,2 ,3 ]
机构
[1] Univ Montreal, Canc Prognost & Hlth Outcomes Unit, Ctr Hlth, Montreal, PQ, Canada
[2] CHUM, CR, Montreal, PQ, Canada
[3] Inst Canc Montreal, Montreal, PQ, Canada
[4] Univ Milan, Acad Dept Urol, IRCCS Policlin San Donato, Corso San Gottardo 12, I-20136 Milan, MI, Italy
[5] IRCCS Osped San Raffaele, Unit Urol, Urol Res Inst, Div Oncol, Milan, Italy
[6] Univ Vita Salute San Raffaele, Milan, Italy
[7] Univ Med Ctr Hamburg Eppendorf, Martini Klin, Hamburg, Germany
[8] Univ G dAnnunzio, SS Annunziata Hosp, Dept Urol, Chieti, Italy
[9] Med Univ Vienna, Dept Urol, Vienna, Austria
[10] Univ Milan, Dept Urol, IRCCS Fdn Ca Granda Osped Maggiore Policlin, Milan, Italy
关键词
cystectomy; robotic surgery; National Inpatient Sample; bladder cancer; COSTS; MORBIDITY;
D O I
10.1089/end.2018.0313
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Radical cystectomy represents the standard of care for muscle-invasive bladder cancer (MIBC). Due to its novelty the use of robotic radical cystectomy (RARC) is still under debate. We examined intraoperative and postoperative morbidity and mortality in addition to impact on length of stay (LOS) and total hospital charges (THCGs) of RARC compared with open radical cystectomy (ORC). Materials and Methods: Within National Inpatient Sample (2008-2013), we identified patients with nonmetastatic bladder cancer treated with either ORC or RARC. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between ORC vs RARC. Multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used. Results: Of all 10,027 patients, 12.6% underwent RARC. Between 2008 and 2013, RARC rates increased from 0.8% to 20.4% [estimated annual percentage change (EAPC): +26.5%, 95% confidence interval (CI): +11.1 to +48.3; p=0.035] and RARC THCGs decreased from 45,981 to 31,749 United States dollars (EAPC: -6.8%, 95% CI: -9.6 to -3.9; p=0.01). In MLR models RARC resulted in lower rates of overall complications [odds ratio (OR): 0.6; p<0.001] and transfusions (OR: 0.44; p<0.001). In MPR models, RARC was associated with shorter LOS (relative risk 0.91; p<0.001). Finally, higher THCGs (OR: 1.09; p<0.001) were recorded for RARC. Data are retrospective and no tumor characteristics were available. Conclusion: RARC is related to lower rates of overall complications and transfusions rates. In consequence, RARC is a safe and feasible technique in select MIBC patients. Moreover, RARC is associated with shorter LOS, although higher THCGs.
引用
收藏
页码:701 / 709
页数:9
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