Beeinträchtigt die robotergestützte radikale Zystektomie das onkologische Ergebnis bei Blasenkrebspatienten?

Zusammenfassung

Das Einsatzgebiet der roboterassistierten Chirurgie in der Urologie umfasst mittlerweile ein breites Spektrum an Eingriffen. Wesentlich sind dabei neben rekonstruktiven Eingriffen insbesondere tumorchirurgische Eingriffe wie die radikale Zystektomie. Während Untersuchungen zur perioperativen Qualität der robotisch-assistierten radikalen Zystektomie einen günstigen Einfluss auf die Morbidität (und damit auch Mortalität) nahelegen, bleibt die Frage, inwieweit auch die onkologische Qualität des Eingriffs gemessen am rezidivfreien und Gesamtüberleben beeinflusst.

In diesem Kontext werden in dieser Arbeit nach einer umfassenden Literaturrecherche sowohl die Daten retrospektive Kohortenvergleiche zwischen offener und robotischer Zystektomie, Registerdaten zur robotischen Zystektomie sowie die Ergebnisse prospektiv randomisierter Studien dargestellt.

Zusammengefasst ist unter onkologischen Gesichtspunkten die robotische der offenen Zystektomie nicht unterlegen. Die Daten des Gesamtüberlebens, des karzinomspezifischen Überlebens und des progressionsfreien Überlebens unterscheiden sich weder in den retrospektiven Kohortestudien, im indirekten Vergleich von Registerdaten und/oder großer Serien noch in den bisherigen prospektiven Untersuchungen. Im Hinblick auf das Auftreten atypische Metastasen nach robotischer Zystektomie fehlen aktuell prospektive Daten, dies nicht das generelle onkologische Outcome zu beeinflussen.

Damit ist die robotisch-assistierte Zystektomie auch aus onkologischen Gesichtspunkten eine gute Option für Patienten, bei denen eine Indikation zur radikalen Zystektomie besteht.

Abstract

Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.

In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.

In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.

Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.

Schlüsselwörter

Blasenkarzinom - radikale Zystektomie - robotische Zystektomie - Robotische Chirurgie - urologische Onkologie

Keywords

bladder cancer - radical cystectomy - robotic assisted radical cystectomy - robotic surgery - GU oncology

Publication History

Received: 20 October 2021

Accepted: 18 January 2022

Article published online:
28 March 2022

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