Fonseka Thomas, Ahmed Kamran, Froghi Saied, Khan Shahid A, Dasgupta Prokar, Shamim Khan Mohammad
King's College London School of Medicine, London.
Arch Ital Urol Androl. 2015 Mar 31;87(1):41-8. doi: 10.4081/aiua.2015.1.41.
To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC.
A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed.
Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY.
RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.
进行一项系统评价和荟萃分析，比较开放性根治性膀胱切除术（ORC）、腹腔镜根治性膀胱切除术（LRC）和机器人辅助根治性膀胱切除术（RARC）之间的手术结果。将RARC与LRC进行比较，LRC与ORC进行比较。
对文献进行系统评价，整理比较RARC、LRC和ORC的研究。提取手术和肿瘤学结果数据并进行荟萃分析。
共纳入24项研究，分析病例总数为2104例。与LRC相比，RARC的手术时间（OPT）更长，住院时间（LOS）和估计失血量（EBL）无统计学差异。与ORC相比，RARC的LOS显著缩短，EBL减少，并发症发生率更低，OPT更长。淋巴结清扫数量（LNY）和手术切缘阳性率（PSM）无显著差异。与ORC相比，LRC的EBL减少，LOS缩短，OPT增加。LNY无显著差异。
RARC与LRC相当，手术效果优于ORC。LRC的手术结果优于ORC。鉴于机器人手术系统的独特技术特点以及体内重建的增加趋势，RARC可能会成为首选的手术方式。
