Die Roboter-assistierte laparoskopische Zystektomie: Auf dem Weg zu einem Standard-Verfahren?

 

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Zusammenfassung

Einleitung: Die radikale Zystektomie stellt die Standardbehandlung des muskelinvasiven Urothelkarzinoms der Harnblase dar. Minimalinvasive Verfahren – besonders Roboter-assistierte Techniken (RARC) – werden zunehmend für diese Indikation eingesetzt. Hier soll der momentane Stand und die Akzeptanz dieses Verfahrens untersucht werden. Ergebnisse: Der Anteil der RARC ist ein ständig wachsender Bereich mit einer sehr kurzen Lernkurve für Operateure mit Erfahrung in der Roboter-assistierten radikalen Prostatektomie. Die Lymphknotenausbeute ist in einigen Studien als adäquat bezeichnet worden und vergleichbar mit offenen Verfahren. Die Harnableitung erfolgt nach wie vor überwiegend extrakorporal, einige Gruppen haben sich aber bereits einer intrakorporalen Technik verschrieben und viel versprechende Daten publiziert. Die perioperativen Ergebnisse sind günstig. Die kurz- und mittelfristigen onkologischen Analysen sind erwartungsvoll, während endgültige, langfristige Einschätzungen aber noch ausstehen. Schlussfolgerung: RARC mit entsprechender Harnableitung scheint weiterhin in akademischen Institutionen an Bedeutung zu gewinnen. Die breite Verfügbarkeit des Systems wird dies vermutlich noch zusätzlich verstärken. Nach Festlegung der onkologischen Effizienz hat die RARC das Potenzial als ein Standardverfahren für die Behandlung des muskelinvasiven Harblasenkarzinomes akzeptiert zu werden, zumal die perioperative Leistungsfähigkeit sehr gut ist. 

Abstract

Introduction: Radical cystectomy is considered the standard treatment for muscle-invasive bladder cancer. Minimally invasive techniques – especially robot-assisted techniques (RARC) – are being increasingly employed for this indication. Herein, we evaluate the current status of RARC and its acceptance in the urological community. Results: The field of RARC is steadily increasing particularly due to an extremely short learning curve for surgeons with previous experience in robot-assisted radical prostatectomy. Lymph node yield has been shown to be adequate in several independent studies, being comparable to that of the open approach. Urinary diversion is most frequently done extracorporeally while several groups have commited themselves to intracorporeal techniques and have already shown excellent results. The perioperative outcome data compare favourably to those of open cystectomy. Short-term and interim oncological data are promising while a final long-term assessment is still lacking. Conclusions: RARC completed by appropriate urinary diversion is gaining relevance in academic institutions worldwide. The relatively wide availability of the robotic system will further add to this development. Secondary to the final assessment of its oncological efficacy RARC has the potential to become a standard treatment of muscle-invasive bladder cancer since its perioperative efficacy is excellent. 

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C. Schwentner

Klinik für Urologie · Eberhard-Karls Universität · Tübingen

Hoppe-Seyler-Str.

72074 Tübingen

Phone: +49 / 70 71 / 29-8 03 49

Fax: +49 / 70 71 / 29-50 92

Email: christian.schwentner@googlemail.com