| Objective:To investigate the relationship between marginal widths of transurethral resection of bladder tumor, confirmed by postoperative pathology and bladder cancer recurrence to define the ideal resection marginal width.Methods:A total of 143 patients with Ta and T1 non-muscle invasive bladder cancer were retrospectively reviewed. The data were divided into 10,15 and 20 mm groups based on the resection marginal width. The clinical data of 24-month follow-up were analyzed to investigate the tumor recurrence and recurrence in situ. Log-rank test, Cox regression, and Kaplan-Meier method were performed to compare the three groups, respectively.Results:Tumor size, primary/recurrent tumor, pathological grade, resection marginal width, and margin status (positive vs. negative) affected the tumor recurrence. The same factors also affected the tumor recurrence in situ. The recurrence rate and the recurrence in situ rate of 10 mm marginal width group were higher than 15 mm and 20 mm marginal width groups (P=0.005), and the recurrence rate and the recurrence in situ rate in patients with positive margins were higher than those with negative margins (P<0.001). The postoperative complication rate in 20 mm marginal width group was higher compared with the other two groups (P<0.05).Conclusion:The positive margin was significantly related to increased tumor recurrence and recurrence in situ. A marginal width of 15 mm can be recommended as the preferable standard, as it reduced the rates of recurrence and recurrence in situ, without causing any significant increase in the postoperative complications.Objective:To compare the peri-operative data and postoperative complications of robot-assisted laparoscopic radical cystectomy(RARC), laparoscopic radical cystectomy(LRC) and open radical cystectomy(ORC).Methods:A total of 111 cases underwent radical cystectomy and cutaneous ureterostomy during Jan.2010 to Oct.2015 were involved, including 73 open surgery,30 traditional laparoscopic surgery and 8 robot-assisted laparoscopic surgery. The peri-operative status and postoperative complications of each group such as operating time, blood loss, transfusion volume, eating time, extubation time, hospital stay after operation were compared.Results:All operations were successfully completed. The fasting time and hospital stay after operation of the three groups were no difference(p<0.05). The operating time of open group was shorter than the laparoscopic group:240min(210-300min) vs 308min(240-431min) (p=0.002). There was no statistical difference in operating time between open group, laparoscopic and robot group. The blood loss in the robot group was lower than the open group:200ml(150-300ml) vs 1000ml(600-1900ml) (p=0.001) and the laparoscopic group:200ml(150-300ml) vs 800ml(375-1300ml) (p=0.041). The blood loss between the open group and the laparoscopic group had no difference. The transfusion of RBC and plasma in the laparoscopic group and the robot group were both less than in the open group(p<0.05), but no statistical difference between laparoscopic group and the robot group. TNM stage, lymph node positive rate and pathological grade of the three groups were no difference. There was no statistical difference in complication rates of the three groups, and the complication grade (Clavien-Dindo) was also no statistical difference.Conclusion:Robot-assisted laparoscopic radical cystectomy and cutaneous ureterostomy has the advantages of small trauma, little bleeding, and quick postoperative recovery, which is a safe, effective operative method for invasive bladder cancer.Objective:To compare the peri-operative data and postoperative complications of robot-assisted laparoscopic radical cystectomy(RARC), laparoscopic radical cystectomy(LRC) and open radical cystectomy(ORC).Methods:A total of 132 cases underwent radical cystectomy with Bricker ideal neobladder during Jan.2010 to Oct.2015 were involved, including 69 open surgery,57 traditional laparoscopic surgery and 6 robot-assisted laparoscopic surgery. The peri-operative status and postoperative complications of each group such as operating time, blood loss, transfusion volume, fasting time, extubation time, hospital stay after operation were compared.Results:All operations were successfully completed. The fasting time and extubation time of the three groups were no difference(p<0.05). The operating time of open group was shorter than the laparoscopic group:398min(360-450min) vs 435min(390-510min) (p=0.011), but there was no statistical difference in operating time between open group, laparoscopic and robot-assisted group. The blood loss in the robot-assisted group was lower than the laparoscopic group:300ml(200-375ml) vs 700ml (400-1200ml) (p=0.043) and the open group:300ml(200-375ml) vs 1200ml (800-2000ml) (p<0.001), and the blood loss in laparoscopic group was lower than open group(p=0.003). The transfusion of RBC in robot-assisted group was lower than open group:0U (0-0U) vs 6U (4-7.5U) (p=0.001), but no statistical difference was found between laparoscopic group and robot-assisted group. The hospital stay after operation in robot-assisted group was shorter than open group: 11d (10-19.5d) vs 19d (14-23d) (p=0.027), but no difference compared with laparoscopic group. TNM stage, lymph node positive rate and pathological grade of the three groups were no difference. There was no statistical difference in complication rates of the three groups, and the complication grade (Clavien-Dindo) was also no statistical difference.Conclusion:Robot-assisted laparoscopic radical cystectomy with Bricker ideal neobladder has the advantages of small trauma, little bleeding, and quick postoperative recovery, which is a safe, effective operative method for invasive bladder cancer. |
PDF Full Text Request