为了评估机器人辅助根治性膀胱切除术 (RARC) 联合体内尿流改道 (ICUD) 与开放根治性膀胱切除术 (ORC) 对膀胱癌 (BC) 的疗效比较。我们进行了一项现实生活中的单中心研究，包括所有连续接受 RARC 的患者2014 年至 2023 年，我们机构使用 ICUD 或 ORC 治疗 BC。使用单变量和多变量 Logistic 和 Cox 回归分析，通过计算比值 (OR) 和风险 (HR) 比，比较两组之间的围手术期、肿瘤学和狭窄结果。分别对应 95% 置信区间 (CI)。 总体而言，316 名患者接受了 RARC 联合 ICUD (n = 228 [72.2%]) 或 ORC (n = 88 [27.8%])。 RARC 与 ORC 相比的围手术期益处包括降低大失血风险（OR 0.10，95% CI 0.04-0.23；P < 0.001）、围手术期输血风险（OR 0.30，95% CI 0.16-0.57；P < 0.001），90-日内严重并发症（OR 0.56，95% CI 0.29-0.99；P = 0.04），初始住院时间延长（OR 0.20，95% CI 0.09-0.35；P < 0.001），以及更多的存活和出院天数手术后 90 天内住院（OR 2.56，95% CI 1.46-4.6；P<0.01）。此外，使用 RARC 与 ORC 相比，淋巴结 (LN) 计数较高（OR 3.35，95% CI 1.83-6.30；P < 0.001），而无复发率没有显着差异（HR 0.72， 95% CI 0.49-1.07；P = 0.1），癌症特异性（HR 0.69，95% CI 0.43-1.10；P = 0.1），总体（HR 0.76，95% CI 0.47-1.20；P = 0.3）和输尿管-中位（四分位距）随访 42.3 （16.4-73.8） 个月后，两组之间的无回肠狭窄生存率（HR 1.18，95% CI 0.62-2.25；P = 0.6）。我们的真实世界研究支持了有效性BC 的 RARC 与 ICUD 对比 ORC。与 ORC 相比，RARC 加 ICUD 后，我们通常观察到更好的围手术期结果，以及相似的肿瘤学结果（除了较高的 LN 计数和输尿管回肠狭窄结果）。© 2024 作者。 BJU International 约翰·威利 (John Wiley) 出版

To assess the comparative effectiveness of robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) vs open radical cystectomy (ORC) for bladder cancer (BC).We conducted a real-life monocentric study including all consecutive patients who underwent RARC with ICUD or ORC for BC at our institution from 2014 to 2023. Uni- and multivariable logistic and Cox regression analyses were used to compare perioperative, oncological and stricture outcomes between both groups by calculating odds (ORs) and hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs), respectively.Overall, 316 patients underwent either RARC with ICUD (n = 228 [72.2%]) or ORC (n = 88 [27.8%]). The perioperative benefits of RARC vs ORC included decreased risks of major blood loss (OR 0.10, 95% CI 0.04-0.23; P < 0.001), perioperative transfusion (OR 0.30, 95% CI 0.16-0.57; P < 0.001), 90-day major complications (OR 0.56, 95% CI 0.29-0.99; P = 0.04), and prolonged initial length of hospital stay (OR 0.20, 95% CI 0.09-0.35; P < 0.001), as well as more days alive and out of the hospital within 90 days of surgery (OR 2.56, 95% CI 1.46-4.6; P < 0.01). In addition, the use of RARC vs ORC was associated with a higher lymph node (LN) count (OR 3.35, 95% CI 1.83-6.30; P < 0.001), while there was no significant difference in recurrence-free (HR 0.72, 95% CI 0.49-1.07; P = 0.1), cancer-specific (HR 0.69, 95% CI 0.43-1.10; P = 0.1), overall (HR 0.76, 95% CI 0.47-1.20; P = 0.3) and uretero-ileal stricture-free (HR 1.18, 95% CI 0.62-2.25; P = 0.6) survival between both groups after a median (interquartile range) follow-up of 42.3 (16.4-73.8) months.Our real-world study supports the effectiveness of RARC with ICUD vs ORC for BC. We generally observed better perioperative outcomes, as well as similar oncological-except for higher LN count-and uretero-ileal stricture outcomes after RARC with ICUD vs ORC.© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.