Cancer - Bladder, Pelvis, Ureter & Others(구연) (E-059)

근치적 방광 절제술의 4가지 요인: 로봇 보조 근치적 방광 절제술의 초기 성적을 표준화할 수 있는 요인의 제안 및 수술 경험의 영향
성균관대학교 의과대학 비뇨의학과교실
송 완, 정재훈, 강민용, 성현환, 전황균, 서성일, 전성수, 이현무, 정병창
Purpose: To propose a comprehensive method for reporting early outcomes following robotic-assisted radical cystectomy (RARC)
Materials and methods: We retrospectively reviewed 192 men who underwent RARC with extracorporeal urinary diversion (UD) for bladder cancer (BCa) between April 2009 and April 2020. Clinicopathologic characteristics and peri-operative findings were identified. Complications were stratified according to the Clavien-Dindo (CD) classification system. Patients who simultaneously demonstrated ≥16 lymph node (LN) yield, negative soft tissue surgical margins (STSMs), no transfusion and absence of major complications (no CD ≥ 3) at 30 days were considered to have obtained the RARC-tetrafecta. A multivariable logistic regression analysis was performed to measure predictors for achieving RARC-tetrafecta.
Results: As early outcomes, ≥16 LN yield, negative STSMs, no transfusion and absence of major complications (no CD ≥ 3) were identified in 70.9%, 92.6%, 74.1% and 91.5% patients, respectively. A total of RARC-tetrafecta achievement rate was 48.1%, and when compared according to the type of UD (ileal conduit vs. ileal neobldder), there was no significant difference (40.8% vs. 52.5%, P = 0.119). The proportion of patients achieving the RARC-tetrafecta increase with surgical experience from 41.7% in the first tertile to 52.8% in the last tertile. Multivariable logistic regression analysis revealed age (odds ratio [OR] 0.97; P = 0.024) and pathologic N stage (OR 1.11; P < 0.001) as independent predictors for achieving RARC-tetrafecta.
Conclusions: We present a RARC-tetrafecta as a comprehensive method for reporting early outcomes. This tool may be useful for assessing the quality and the learning curve of RARC.
keywords : bladder cancer, robotic-assisted radical cystectomy, tetrafecta

프린트