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| 在一个大的队列中由ESUT批判性分析腹腔镜根治性膀胱切除术后早期复发 Critical Analysis of Early Recurrence after Laparoscopic Radical Cystectomy in a Large Cohort by the ESUT
摘要 PURPOSE: 目的： We analyze patients with early progression after laparoscopic radical cystectomy in a large cohort by the ESUT (European Association of Urology Section of Uro-Technology). More specifically we focus on patients with favorable pathology (pT2 N0 R0 or less) who experienced an unexpected recurrence and analyze possible causes for such early recurrence, discussing the surgical technique including pneumoperitoneum. 我们分析患者行腹腔镜根治性膀胱切除术后早期发展的大型队列由ESUT（欧洲泌尿科协会技术部）。更具体地说，更具体地说，我们专注于患者具良好的病理学（PT2 N0 R0或更少）谁经历了意外的复发和分析这种早期复发的可能原因，探讨手术方法包括气腹。 MATERIALS AND METHODS: 材料与方法： Since 2000 the ESUT has been constructing a large, multicenter, prospective database of patients undergoing laparoscopic radical cystectomy. All procedures were performed via a standard laparoscopic approach without robotic assistance. We specifically analyzed patients with favorable pathological characteristics, in particular pT2 N0 R0 or less, and evaluated those with progression despite these favorable characteristics. Univariate and multivariate logistic regression was performed to evaluate risk factors for early recurrence. 自2000年以来ESUT已构建大型、多中心、腹腔镜根治性膀胱切除术患者的前瞻性数据库。所有的程序都是通过一个标准的腹腔镜手术方法，没有机器人援助。我们具体分析了有利的病理特征的患者，特别是PT2 N0 R0或更少，并评估这些发展尽管这些有利的特点。对早期复发的危险因素进行单因素和多因素的多因素回归分析。 RESULTS: 结果: A total of 627 patients were available for final analysis with a median followup of 46 months (mean 57). Of these patients 311 had favorable pathological characteristics of pT2 N0 R0 or less. During followup 27 (8.7%) patients experienced disease progression during the first 24 months. Surgical negligence was found in only 1 case. Most of these patients with early recurrence had progression to high tumor volume disseminated metastatic disease. On multivariate logistic regression tumor stage was the only factor significantly associated with early recurrence (p=0.027). 共627例是可用的，与随访结果分析46个月（平均57）。这些患者中有311例有良好的病理特征PT2 N0 R0或较少，不太有利的病理特点。随访中27（8.7%）患者在头24个月内经历了疾病的进展。仅发现1例手术中的疏忽。大多数早期复发的患者有进展为高肿瘤体积的播散性转移性疾病。多因素回归分析，肿瘤分期是早期复发的唯一显著因素（P = 0.027）。 CONCLUSIONS: 结论： We report early unexpected recurrences after laparoscopic radical cystectomy in nearly 5% of our entire cohort, all in patients with favorable pathological characteristics (pT2 N0 R0 or less). Pneumoperitoneum may have had a role in the development of these relapses. Specifically designed studies are necessary to investigate the possible role of pneumoperitoneum in urothelial cancer recurrence. 我们报告我们整个队列近5%腹腔镜根治性膀胱切除术后早期复发意外，所有患者均具有良好的病理特征（PT2 N0 R0或更少）。在这些复发的发展气腹可能有作用。专门研究是必要的调查气腹尿路上皮癌复发的可能作用。 原文: |
