surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2024-14-1-5-12surgonco-910Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESВыживаемость пациентов с мышечно-инвазивным раком мочевого пузыря после робот-ассистированной радикальной цистэктомии с интракорпоральной деривацией мочиSurvival in patients with muscle-invasive bladder cancer after robot-assisted radical cystectomy with intracorporeal urinary derivationhttps://orcid.org/0000-0003-2125-4897ПавловВ. Н.PavlovV. N.

Павлов Валентин Николаевич — д.м.н., профессор, академик РАН, кафедра урологии

Республика Башкортостан, Уфа 

Valentin N. Pavlov — Dr. Sci. (Med.), Prof., Academician of the Russian Academy of Sciences, Department of Urology

Ufa

https://orcid.org/0000-0002-4657-6625УрманцевМ. Ф.UrmantsevM. F.

Урманцев Марат Фаязович — к.м.н., доцент, кафедра урологии

Республика Башкортостан, Уфа 

Marat F. Urmantsev — Cand. Sci. (Med.), Assoc. Prof., Department of Urology

Ufa

 

urmantsev85@mail.ruБакеевМ. Р.BakeevM. R.

Бакеев Марат Радикович — студент 6-го курса

Республика Башкортостан, Уфа 

Marat R. Bakeev — 6th year Student

Ufa

Башкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian Federation202418042024141512Copyright © Павлов В.Н., Урманцев М.Ф., Бакеев М.Р., 20242024Павлов В.Н., Урманцев М.Ф., Бакеев М.Р.Pavlov V.N., Urmantsev M.F., Bakeev M.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/910Ведение

Ведение. Мировым стандартом лечения мышечно-инвазивного рака мочевого пузыря (РМП) выступает радикальная цистэктомия (РЦ) с тазовой лимфаденэктомией (ТЛАЭ). Данные ряда крупных исследований свидетельствуют о значительных послеоперационных осложнениях РЦ. В 2003 г. бригадой урологов под руководством M. Menon впервые были проведены серии робот-ассистированных РЦ (РАРЦ). В настоящее время появилась возможность оценивать выживаемость пациентов после РАРЦ.

Цель исследования

Цель исследования: определение показателей общей (ОВ), опухоль-специфической (ОСВ) и безрецидивной выживаемости (БРВ) после РАРЦ с ТЛАЭ у пациентов с мышечно-инвазивным РМП, оперированных на базе одного центра.

Материалы и методы

Материалы и методы. За период 2018–2023 гг. в онкологическом отделении на базе Клиники ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава РФ было прооперировано 200 пациентов с мышечно-инвазивным РМП. Оперативная методика заключалась в выполнении РАРЦ с интракорпоральной деривацией мочи. Максимальный период наблюдения за пациентами ограничивался 36 месяцами. Проводился анализ выживаемости в общей когорте пациентов, а также после стратификации по статусу pN (+/–). С целью визуализации полученных результатов применялись кривые Kaplan-Meier.

Результаты и обсуждение

Результаты и обсуждение. По истечении 36 месяцев ОВ среди всех прооперированных пациентов составила 48,25 %, ОСВ — 57,49 %, БРВ — 61,89 % (p = 0,0031, χ² = 11,325). Также наблюдается достоверно значимое уменьшение всех показателей выживаемости среди пациентов pN (+), p < 0,0001. В структуре группы pN (+) выявлено преобладание пациентов с повышенной стадией pT по сравнению с группой pN (–).

Заключение

Заключение. По результатам анализа выживаемости после РАРЦ наблюдаются удовлетворительные отдаленные онкологические результаты. В структуре причин смертности после РАРЦ лидирующие позиции занимают поражение регионарных лимфатических узлов и повышенная стадия pT.

Introduction

Introduction. The world standard for treating muscle-invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy. Several large studies report significant postoperative complications of radical cystectomy. In 2003, a team of urologists led by Mani Menon performed a series of robot-assisted radical cystectomies (RARC) for the first time. Currently, it is possible to evaluate the survival of patients aft er RARC.

Aim

Aim. To determine the indicators of overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS) aft er RARC with pelvic lymphadenectomy in patients with muscle-invasive bladder cancer that were operated at a single center.

Materials and methods

Materials and methods. In 2018–2023, 200 patients with muscle-invasive bladder cancer were operated at the Oncology Department of the Bashkir State Medical University Clinic. The operation procedure involved performing RARC with intracorporeal urinary derivation. The maximum follow-up period was limited to 36 months. The survival analysis was performed for the total cohort of patients, as well as following stratification for pN (+/–) status. In order to visualize the obtained results, Kaplan-Meier curves were used.

Results and discussion

Results and discussion. After 36 months, the survival indicators of all operated patients were as follows: OS — 48.25%; CSS — 57.49%; RFS — 61.89% (p = 0.0031, χ2 = 11.325). Also, a significant decrease in all the survival indicators of pN (+) patients was observed, p < 0.0001. In the pN (+) patient group, patients with advanced pT stage were found to be predominant as compared to the pN (–) group.

Conclusion

Conclusion. The analysis of survival after RARC shows satisfactory longterm oncologic outcomes. After RARC, the leading causes of death are regional lymph node involvement and advanced pT stage.

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The authors declare that there are no conflicts of interest present.