Impact of outcomes and costs for implementation of robotic radical cystectomy with full intracorporeal urinary diversion.

IF 1.4 Q3 UROLOGY & NEPHROLOGY Central European Journal of Urology Pub Date : 2023-01-01 Epub Date: 2023-11-15 DOI:10.5173/ceju.2023.203
Razvan George Rahota, Jean-Baptiste Beauval, Jean-Romain Gautier, Christophe Almeras, Valerie Garnault, Guillaume Loison, Ambroise Salin, Christophe Tollon, Guillaume Ploussard
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Abstract

Introduction: Radical cystectomy (RC) remains a surgery with important morbidity despite technical advances. Our aim was to determine the impact on outcomes and costs of robot-assisted radical cystectomy (RARC) with full intracorporeal diversion.

Material and methods: We retrospectively included 196 consecutive patients undergone RC for bladder cancer between 2017 and 2022. Comparisons were done between the open radical cystectomy (ORC; n = 166) and RARC with full intracorporeal diversion (n = 30) in the overall cohort and after matched pair analysis.

Results: More neobladders were performed in the RARC group (40% vs 18.7%, p = 0.011). Peri-operative parameters continuously improved over time in the RARC cohort despite an increased proportion of elderly patients with higher comorbidity index. RARC patients had lower prolonged stay (33.3% vs 68.3%, p = 0.002), lower grade 1 complication rates (26.7% vs 53.3%, p = 0.016) and blood loss (185 vs 611 ml, p <0.001) than ORC patients. RARC was an independent favorable predictor for prolonged stay (OR 0.199) and complication (OR 0.334). Cost balance favored ORC, with an increase of hospitalization cost at 816 euros for RARC.

Conclusions: After matching, RARC with full intracorporeal diversion was associated with improved outcomes and a moderated increase of post-operative costs mainly due to the use of robotic devices.

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实施机器人根治性膀胱切除术并进行完全体外尿路转流对疗效和成本的影响。
导言:尽管技术不断进步,根治性膀胱切除术(RC)仍然是一种发病率很高的手术。我们的目的是确定完全体腔内转流的机器人辅助根治性膀胱切除术(RARC)对预后和成本的影响:我们回顾性纳入了 2017 年至 2022 年间接受膀胱癌根治术的 196 例连续患者。在总体队列和配对分析后,比较了开放根治性膀胱切除术(ORC;n = 166)和全体外转流 RARC(n = 30):结果:RARC组进行新膀胱术的比例更高(40% vs 18.7%,p = 0.011)。尽管合并症指数较高的老年患者比例增加,但随着时间的推移,RARC 组患者的围手术期参数持续改善。经过匹配后,采用完全体腔内转流的 RARC 可改善疗效,但术后费用的增加有限,这主要是由于使用了机器人设备。
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来源期刊
Central European Journal of Urology
Central European Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.30
自引率
8.30%
发文量
48
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