Vivek Venkatramani, Isildinha M Reis, Mark L Gonzalgo, Sanjaya Swain, Robert S Svatek, Dipen J Parekh
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引用次数: 0
Abstract
Purpose: To assess differences in complications and readmissions between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC).
Materials and methods: This study uses data from the per-protocol population of the Randomized Robotic-Assisted vs Open Radical Cystectomy (RAZOR) study; a multicenter, open-label, phase-3, noninferiority clinical trial. RAZOR enrolled across 15 academic medical centers in the United States between 2011 and 2014. The median follow-up was 2 years. Complications up to 90 days using the Clavien-Dindo classification, and readmissions at 90 days and 1 year postoperatively were compared. Multivariable logistic regression analyses were performed to determine any predictors of major complications and of postsurgery readmission.
Results: Baseline characteristics were similar, and there was no significant difference in overall and major complication rates between RARC (n = 150) and ORC (n = 152) arms. Simplified frailty index (sFI) ≥ 3 (HR, 4.22, 95% CI, 2.67-6.66, P < .0001) was a significant predictor of major complications within 90 days. Readmission rates at 90 days were 24.1% for RARC and 23.1% for ORC, and readmission rates at at 1 year were 29.5% for RARC and 28.5% for ORC (P = .80). sFI ≥ 3 was a significant predictor of readmission at both time points (subdistribution HR [sHR] 4.43, 95% CI, 1.75-11.2, P = .002 at 90 days and sHR, 5.28, 95% CI, 2.22-12.6, P = <.001, at 1 year).
Conclusions: No significant differences in major complications and readmission rates between ORC and RARC were noted. Patient frailty was an important predictor of these outcomes, and special attention needs to be taken in ensuring appropriate patient selection and preoperative preparation.
期刊介绍:
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.