机器人与开放泌尿外科肿瘤学手术比较：系统评价和荟萃分析研究方案。

Robotic versus open urological oncological surgery: study protocol of a systematic review and meta-analysis.

机构信息

USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA

USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA.

出版信息

BMJ Open. 2020 Feb 10;10(2):e036609. doi: 10.1136/bmjopen-2019-036609.

DOI:10.1136/bmjopen-2019-036609

PMID:32047022

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7044973/

Abstract

INTRODUCTION

Minimally invasive surgery in urology has grown considerably in application since its initial description in the early 1990s. Herein, we present the protocol for a systematic review and meta-analysis comparing open versus robotic urological oncological surgery for various clinically relevant outcomes, as well as to assess their comparative penetrance over the past 20 years (2000-2020).

METHODS AND ANALYSIS

We will document the penetrance of robotic versus open surgery in the urological oncological field using a national database.Second, we will perform a systematic review and meta-analysis of all published full-text English and non-English language articles from Pubmed, Scopus and Web of Science search engines on surgical treatment of localised prostate, bladder, kidney and testis cancer published between 1st January 2000 to 10th January 2020. We will focus on the highest-volume urological oncological surgeries, namely, radical prostatectomy, radical cystectomy, partial nephrectomy, radical nephrectomy and retroperitoneal lymph node dissection. Study inclusion criteria will comprise clinical trials and prospective and retrospective studies (cohort or case-control series) comparing robotic versus open surgery. Exclusion criteria will comprise meta-analyses, multiple papers with overalapping study-periods, studies analysing national databases and case series describing only one approach (robotic or open). Risk of bias for included studies will be assessed by the appropriate Cochrane risk of bias tool. Principal outcomes assessed will include perioperative, functional, oncological survival and financial outcomes of open versus robotic uro-oncological surgery. Sensitivity analyses will be performed to correlate outcomes of interest with key baseline characteristics and surrogates of surgical expertise.

ETHICS AND DISSEMINATION

This comprehensive systematic review and meta-analysis will provide rigorous, consolidated information on contemporary outcomes and trends of open versus robotic urological oncological surgery based on all the available literature. These aggregate data will help physicians better advise patients seeking surgical care for urological cancers.

PROSPERO REGISTRATION NUMBER

CRD42017064958.

摘要

介绍

自 20 世纪 90 年代初首次描述以来，泌尿外科的微创技术应用得到了极大的发展。在此，我们提出了一项系统评价和荟萃分析的方案，比较了开放手术与机器人泌尿外科肿瘤手术在各种临床相关结局方面的效果，并评估了它们在过去 20 年（2000-2020 年）中的比较优势。

方法和分析

我们将使用国家数据库记录机器人手术与开放手术在泌尿外科肿瘤领域的优势。其次，我们将对 Pubmed、Scopus 和 Web of Science 搜索引擎上发表的所有关于局部前列腺癌、膀胱癌、肾癌和睾丸癌的全英文和非英文文献进行系统评价和荟萃分析，这些文献的手术治疗时间为 2000 年 1 月 1 日至 2020 年 1 月 10 日。我们将重点关注泌尿外科肿瘤领域的最大手术量，即根治性前列腺切除术、根治性膀胱切除术、部分肾切除术、根治性肾切除术和腹膜后淋巴结清扫术。纳入研究的标准将包括比较机器人手术与开放手术的临床试验以及前瞻性和回顾性研究（队列或病例对照研究）。排除标准将包括荟萃分析、具有重叠研究期的多份论文、分析国家数据库的研究以及仅描述一种方法（机器人或开放）的病例系列。纳入研究的偏倚风险将由适当的 Cochrane 偏倚风险工具评估。主要评估结果将包括开放与机器人泌尿外科肿瘤手术的围手术期、功能、肿瘤生存和财务结局。将进行敏感性分析，以将相关结局与关键基线特征和手术专业知识的替代指标相关联。