Ahmed Elshabrawy, Hanzhang Wang, Furkan Dursun, Dharam Kaushik, Michael Liss, Robert S Svatek, Ahmed M Mansour
{"title":"机器人辅助根治性膀胱切除术的扩散：全国趋势、预测因素以及与大陆性尿路改道的关联。","authors":"Ahmed Elshabrawy, Hanzhang Wang, Furkan Dursun, Dharam Kaushik, Michael Liss, Robert S Svatek, Ahmed M Mansour","doi":"10.1080/2090598X.2022.2032562","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess the utilisation trends of robot-assisted radical cystectomy (RARC), rates of performing continent urinary diversions (CUDs), and impact of diffusion of RARC on CUD rates.</p><p><strong>Methods: </strong>We investigated the National Cancer Database for patients with muscle-invasive bladder cancer (MIBC) who underwent RC between 2004 and 2015. Patients were stratified by surgical technique into open (ORC) and RARC groups, and by type of urinary diversion into continent (CUD) and ileal conduit (ICUD) groups. Linear regression models were fitted to evaluate time trends for surgery and conversion techniques. Multivariate logistic regression models were utilised to identify independent predictors of RARC and CUD.</p><p><strong>Results: </strong>A total of 14466 patients underwent RC for MIBC, of which 4914 (34%) underwent RARC. There was a significant increase in adoption of RARC from 22% in 2010 to 40% in 2015 (R<sup>2</sup> = 0.96, <i>P</i> < 0.001), this was not associated with a change in the rates of CUD over the same period (<i>P</i> = 0.22). Across all years, ICUD was the primary type of urinary diversion, CUD was only offered in 12% in 2010 compared to 9.9% in 2015 (R<sup>2</sup> = 0.33, <i>P</i> = 0.22). Multivariate analysis identified male gender (odds ratio [OR] 1.18, <i>P</i> = 0.03), academic centres (OR 1.74, <i>P</i> = 0.001), and lower T stage (T4 vs T2; OR 0.78, <i>P</i> = 0.03) as independent predictors of CUD, while surgical technique was not associated with odds of receiving CUD (<i>P</i> = 0.8).</p><p><strong>Conclusions: </strong>There is significant nationwide increasing trend of adoption of RARC. This diffusion was not associated with a decline in CUD, which remains significantly underutilised in both ORC and RARC groups. <b>Abbreviations</b> CUD: continent urinary diversion; ICD-O: International Classification of Diseases for Oncology; ICUD: ileal conduit urinary diversion; (N)MIBC: (non-)muscle-invasive bladder cancer; NAC, neoadjuvant chemotherapy; NCDB: National Cancer Database; OR: odds ratio;(O)(RA)RC: (open) (robot-assisted) radical cystectomy.</p>","PeriodicalId":8113,"journal":{"name":"Arab Journal of Urology","volume":"20 3","pages":"159-167"},"PeriodicalIF":1.3000,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354633/pdf/","citationCount":"0","resultStr":"{\"title\":\"Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion.\",\"authors\":\"Ahmed Elshabrawy, Hanzhang Wang, Furkan Dursun, Dharam Kaushik, Michael Liss, Robert S Svatek, Ahmed M Mansour\",\"doi\":\"10.1080/2090598X.2022.2032562\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To assess the utilisation trends of robot-assisted radical cystectomy (RARC), rates of performing continent urinary diversions (CUDs), and impact of diffusion of RARC on CUD rates.</p><p><strong>Methods: </strong>We investigated the National Cancer Database for patients with muscle-invasive bladder cancer (MIBC) who underwent RC between 2004 and 2015. Patients were stratified by surgical technique into open (ORC) and RARC groups, and by type of urinary diversion into continent (CUD) and ileal conduit (ICUD) groups. Linear regression models were fitted to evaluate time trends for surgery and conversion techniques. Multivariate logistic regression models were utilised to identify independent predictors of RARC and CUD.</p><p><strong>Results: </strong>A total of 14466 patients underwent RC for MIBC, of which 4914 (34%) underwent RARC. There was a significant increase in adoption of RARC from 22% in 2010 to 40% in 2015 (R<sup>2</sup> = 0.96, <i>P</i> < 0.001), this was not associated with a change in the rates of CUD over the same period (<i>P</i> = 0.22). Across all years, ICUD was the primary type of urinary diversion, CUD was only offered in 12% in 2010 compared to 9.9% in 2015 (R<sup>2</sup> = 0.33, <i>P</i> = 0.22). Multivariate analysis identified male gender (odds ratio [OR] 1.18, <i>P</i> = 0.03), academic centres (OR 1.74, <i>P</i> = 0.001), and lower T stage (T4 vs T2; OR 0.78, <i>P</i> = 0.03) as independent predictors of CUD, while surgical technique was not associated with odds of receiving CUD (<i>P</i> = 0.8).</p><p><strong>Conclusions: </strong>There is significant nationwide increasing trend of adoption of RARC. 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Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion.
Objectives: To assess the utilisation trends of robot-assisted radical cystectomy (RARC), rates of performing continent urinary diversions (CUDs), and impact of diffusion of RARC on CUD rates.
Methods: We investigated the National Cancer Database for patients with muscle-invasive bladder cancer (MIBC) who underwent RC between 2004 and 2015. Patients were stratified by surgical technique into open (ORC) and RARC groups, and by type of urinary diversion into continent (CUD) and ileal conduit (ICUD) groups. Linear regression models were fitted to evaluate time trends for surgery and conversion techniques. Multivariate logistic regression models were utilised to identify independent predictors of RARC and CUD.
Results: A total of 14466 patients underwent RC for MIBC, of which 4914 (34%) underwent RARC. There was a significant increase in adoption of RARC from 22% in 2010 to 40% in 2015 (R2 = 0.96, P < 0.001), this was not associated with a change in the rates of CUD over the same period (P = 0.22). Across all years, ICUD was the primary type of urinary diversion, CUD was only offered in 12% in 2010 compared to 9.9% in 2015 (R2 = 0.33, P = 0.22). Multivariate analysis identified male gender (odds ratio [OR] 1.18, P = 0.03), academic centres (OR 1.74, P = 0.001), and lower T stage (T4 vs T2; OR 0.78, P = 0.03) as independent predictors of CUD, while surgical technique was not associated with odds of receiving CUD (P = 0.8).
Conclusions: There is significant nationwide increasing trend of adoption of RARC. This diffusion was not associated with a decline in CUD, which remains significantly underutilised in both ORC and RARC groups. Abbreviations CUD: continent urinary diversion; ICD-O: International Classification of Diseases for Oncology; ICUD: ileal conduit urinary diversion; (N)MIBC: (non-)muscle-invasive bladder cancer; NAC, neoadjuvant chemotherapy; NCDB: National Cancer Database; OR: odds ratio;(O)(RA)RC: (open) (robot-assisted) radical cystectomy.
期刊介绍：
The Arab Journal of Urology is a peer-reviewed journal that strives to provide a high standard of research and clinical material to the widest possible urological community worldwide. The journal encompasses all aspects of urology including: urological oncology, urological reconstructive surgery, urodynamics, female urology, pediatric urology, endourology, transplantation, erectile dysfunction, and urinary infections and inflammations. The journal provides reviews, original articles, editorials, surgical techniques, cases reports and correspondence. Urologists, oncologists, pathologists, radiologists and scientists are invited to submit their contributions to make the Arab Journal of Urology a viable international forum for the practical, timely and state-of-the-art clinical urology and basic urological research.
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