Mullen Emma, Ahmed Kamran, Challacombe Ben
MRC Centre for Transplantation, King's College LondonLondon, UK.
Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health PartnersLondon, UK.
Rev Urol. 2017;19(1):32-43. doi: 10.3909/riu0691.
Upper tract urothelial carcinoma is a relatively uncommon malignancy. The gold standard treatment for this type of neoplasm is an open radical nephroureterectomy with excision of the bladder cuff. This systematic review compares the perioperative and oncologic outcomes for the open surgical method with the alternative surgical management options of laparoscopic nephroureterectomy and robot-assisted nephroureterectomy (RANU). MEDLINE, EMBASE, PubMed, and Cochrane Library databases were searched using a sensitive search strategy. Article inclusion was then assessed by review of abstracts and full papers were read if more detail was required. In all, 50 eligible studies were identified that looked at perioperative and oncologic outcomes. The range for estimated blood loss when examining observational studies was 296 to 696 mL for open nephroureterectomy (ONU), 130 to 479 mL for laparoscopic nephroureterectomy (LNU), and 50 to 248 mL for RANU. The one randomized controlled trial identified reported estimated blood loss and length of stay results in which LNU was shown to be superior to ONU ( < .001). No statistical significance was found, however, following adjustment for confounding variables. Although statistically insignificant results were found when examining outcomes of RANU studies, they were promising and comparable with LNU and ONU with regard to oncologic outcomes. Results show that laparoscopic techniques are superior to ONU in perioperative results, and the longer-term oncologic outcomes look comparable. There is, however, a paucity of quality evidence regarding ONU, LNU, and RANU; data that address RANU outcomes are particularly scarce. As the robotic field within urology advances, it is hoped that this technique will be investigated further using gold standard research methods.
上尿路尿路上皮癌是一种相对罕见的恶性肿瘤。这类肿瘤的金标准治疗方法是开放性根治性肾输尿管切除术并切除膀胱袖口。本系统评价比较了开放性手术方法与腹腔镜肾输尿管切除术和机器人辅助肾输尿管切除术（RANU）等替代手术管理方案的围手术期和肿瘤学结局。使用敏感的检索策略对MEDLINE、EMBASE、PubMed和Cochrane图书馆数据库进行了检索。然后通过摘要审查评估文章纳入情况，如有需要则阅读全文。总共确定了50项符合条件的研究，这些研究关注围手术期和肿瘤学结局。在观察性研究中，开放性肾输尿管切除术（ONU）的估计失血量范围为296至696 mL，腹腔镜肾输尿管切除术（LNU）为130至479 mL，RANU为50至248 mL。确定的一项随机对照试验报告了估计失血量和住院时间结果，其中显示LNU优于ONU（<0.001）。然而，在对混杂变量进行调整后，未发现统计学意义。虽然在检查RANU研究的结局时发现结果无统计学意义，但它们很有前景，在肿瘤学结局方面与LNU和ONU相当。结果表明，腹腔镜技术在围手术期结果方面优于ONU，长期肿瘤学结局看起来相当。然而，关于ONU、LNU和RANU的高质量证据很少；涉及RANU结局的数据尤其稀缺。随着泌尿外科机器人领域的发展，希望使用金标准研究方法对该技术进行进一步研究。
