Rai Bhavan Prasad, Shelley Mike, Coles Bernadette, Biyani Chandra S, El-Mokadem Ismail, Nabi Ghulam
Department of Urology, Academic Clinical Practice, Division of Clinical and Population Sciences, University of Dundee, Dundee, UK.
Cochrane Database Syst Rev. 2011 Apr 13(4):CD007349. doi: 10.1002/14651858.CD007349.pub2.
Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches to manage this condition including open radical nephroureterectomy and laparoscopic procedures.
To determine the best surgical management option for upper tract transitional cell carcinoma.
A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science®, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings.
The following criteria that were considered for this review.Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma. Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma. Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes.
Two review authors examined the search results independently to identify trials for inclusion.
We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P < 0.001) and mean time to discharge (2.3 days versus 3.7, P < 0.001). Oncological outcomes (bladder tumour-free survival, metastasis-free survival, cancer-specific survival curves), at a median follow up of 44 months and in organ-confined disease, were comparable for both groups.
AUTHORS' CONCLUSIONS: There is no high quality evidence available from adequately controlled trials to determine the best surgical management of upper tract transitional cell carcinoma. However, one small randomised trial and observational data suggests that laparoscopic approach is associated with less blood loss and early recovery from surgery with similar cancer outcomes when compared to open approach.
上尿路移行细胞癌（TCC）是一种罕见且侵袭性强的肿瘤。有多种手术方法可用于治疗这种疾病，包括开放性根治性肾输尿管切除术和腹腔镜手术。
确定上尿路移行细胞癌的最佳手术治疗方案。
制定了一种敏感的检索策略，以识别纳入本综述的相关研究。检索了以下数据库以查找评估上尿路TCC手术治疗方法的随机试验：医学文献数据库（Medline）、荷兰医学文摘数据库（EMBASE）、考克兰对照试验中心注册库（CENTRAL）、护理学与健康领域数据库（CINAHL）、英国护理索引数据库、联合和补充医学数据库（AMED）、拉丁美洲及加勒比地区健康科学数据库（LILACS）、科学引文索引数据库（Web of Science®）、Scopus数据库、生物学文摘数据库、循证医学数据库（TRIP）、生物医学中心数据库、论文摘要数据库和ISI会议录数据库。
本综述考虑了以下标准。研究类型——所有比较治疗局限性上尿路移行细胞癌的各种手术方法和途径的随机或准随机对照试验。参与者类型——所有患有局限性移行细胞癌的成年患者。局限性疾病定义为仅限于肾脏或输尿管，影像学检查未发现明显区域淋巴结肿大。干预类型——治疗局限性上尿路移行细胞癌的任何手术方法或途径。结局指标类型——总生存率和癌症特异性生存率是主要结局指标。手术相关并发症、生活质量和卫生经济学结局是次要结局指标。
两位综述作者独立检查检索结果，以确定纳入的试验。
我们确定了一项符合我们纳入标准的随机对照试验。该试验表明，与开放手术相比，腹腔镜手术的围手术期结局更好。腹腔镜手术在失血方面更具优势且具有统计学意义（104毫升对430毫升，P < 0.001），平均出院时间也更短（2.3天对3.7天，P < 0.001）。在中位随访44个月且疾病局限于器官的情况下，两组的肿瘤学结局（无膀胱肿瘤生存率、无转移生存率、癌症特异性生存曲线）相当。
尚无来自充分对照试验的高质量证据来确定上尿路移行细胞癌的最佳手术治疗方法。然而，一项小型随机试验和观察性数据表明，与开放手术相比，腹腔镜手术的失血量更少，术后恢复更快，癌症结局相似。
