Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
PLoS One. 2014 May 16;9(5):e95667. doi: 10.1371/journal.pone.0095667. eCollection 2014.
More recently laparoscopic radical cystectomy (LRC) has increasingly been an attractive alternative to open radical cystectomy (ORC) and many centers have reported their early experiences in the treatment of bladder cancer. Evaluate the safety and efficacy of LRC compared with ORC in the treatment of bladder cancer.
A systematic search of Medline, Scopus, and the Cochrane Library was performed up to Mar 1, 2013. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative, pathologic and oncological variables, and post-op neobladder function and complications.
Sixteen eligible trials evaluating LRC vs ORC were identified including seven prospective and nine retrospective studies. Although LRC was associated with longer operative time (p<0.001), patients might benefit from significantly fewer overall complications (p<0.001), less blood loss (p<0.001), shorter length of hospital stay (p<0.001), less need of blood transfusion (p<0.001), less narcotic analgesic requirement (p<0.001), shorter time to ambulation (p = 0.03), shorter time to regular diet (p<0.001), fewer positive surgical margins (p = 0.006), fewer positive lymph node (p = 0.05), lower distant metastasis rate (p = 0.05) and fewer death (p = 0.004). There was no significant difference in other demographic parameters except for a lower ASA score (p = 0.01) in LRC while post-op neobladder function were similar between the two groups.
Our data suggest that LRC appears to be a safe, feasible and minimally invasive alternative to ORC with reliable perioperative safety, pathologic & oncologic efficacy, comparable post-op neobladder function and fewer complications. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric, long-term follow-up studies and randomized control trials should be undertaken to confirm our findings.
最近，腹腔镜根治性膀胱切除术（LRC）越来越成为开放式根治性膀胱切除术（ORC）的替代选择，许多中心已经报告了他们在膀胱癌治疗方面的早期经验。评估 LRC 与 ORC 在膀胱癌治疗中的安全性和疗效。
系统检索了 Medline、Scopus 和 Cochrane 图书馆，截至 2013 年 3 月 1 日。评估两种技术的感兴趣结果包括人口统计学和临床基线特征、围手术期、病理和肿瘤学变量以及术后新膀胱功能和并发症。
共确定了 16 项评估 LRC 与 ORC 的合格试验，包括 7 项前瞻性和 9 项回顾性研究。尽管 LRC 与手术时间较长相关（p<0.001），但患者可能受益于总并发症明显减少（p<0.001）、出血量减少（p<0.001）、住院时间缩短（p<0.001）、输血需求减少（p<0.001）、需要麻醉性镇痛药减少（p<0.001）、下床时间缩短（p=0.03）、常规饮食时间缩短（p<0.001）、切缘阳性率降低（p=0.006）、阳性淋巴结减少（p=0.05）、远处转移率降低（p=0.05）和死亡人数减少（p=0.004）。除了 LRC 中的较低的 ASA 评分（p=0.01）外，其他人口统计学参数没有显著差异，而两组之间术后新膀胱功能相似。
我们的数据表明，LRC 似乎是 ORC 的一种安全、可行和微创的替代方法，具有可靠的围手术期安全性、病理和肿瘤学疗效、相似的术后新膀胱功能和更少的并发症。由于纳入研究的固有局限性，应进行进一步的大型样本前瞻性、多中心、长期随访研究和随机对照试验，以证实我们的发现。
