Feng Dechao, Li Ao, Hu Xiao, Lin Tianhai, Tang Yin, Han Ping
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China -
Minerva Urol Nefrol. 2020 Jun;72(3):251-264. doi: 10.23736/S0393-2249.20.03680-2. Epub 2020 Feb 19.
Our aim is to compare feasibility and safety of open radical cystectomy (ORC), laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for the treatment of bladder cancer through network meta-analysis.
Eligible articles were identified from electronic databases including PubMed/Medline, Embase, the Cochrane Library and Web of Science up to August 2019 with no language limitations. Studies selection, quality assessment, data extraction and analysis were accomplished by two independent reviewers (DCF and AL) using Cochrane Collaboration's tools.
After screening 2528 articles, 27 studies were included in the final meta-analysis. In the network meta-analysis, both RARC (MD:83.09, 95% CI: 61.06 to 105.11) and LRC (MD: 49.68, 95% CI: 21.75 to 77.62) showed a longer operative time compared with ORC. Besides, RARC had a longer operative time than LRC (MD: 33.40, 95% CI: 1.35 to 65.45). RARC (MD:-591.86, 95% CI: -879.46 to -304.27) and LRC (MD: -435.28, 95% CI: -854.98 to -15.58) showed a less estimated blood loss (EBL) than ORC; however, the difference in EBL for RARC versus LRC was not significant. RARC (OR: 0.26, 95% CI: 0.14 to 0.50) and LRC (OR: 0.23, 95% CI: 0.13 to 0.43) had a higher blood transfusion rate than ORC; however, the OR between RARC and LRC was not significant. RARC (MD: -1.34, 95% CI: -2.55 to -0.12) and LRC (MD: -1.35, 95% CI: -2.38 to -0.32) took a shorter time to regular diet compared with ORC; however, there was no significant difference between RARC and LRC. Compared with ORC, RARC (MD: -2.37, 95% CI: -3.57 to -1.17) and LRC (MD: -2.22, 95% CI: -4.04 to -0.40) showed a shorter length of stay (LOS); however, the difference in LOS for RARC versus LRC was not significant. RARC, LRC and ORC were comparable with regard to minor complications, major complications, positive surgical margin and lymph node yields.
Current evidence indicates that minimally invasive approaches could be considered as a feasible and safe alternative to ORC when performed by experienced surgeons in selected patients. Notably, RARC may be more suitable for RC with extracorporeal urinary diversion. Larger well-designed trials are still needed to confirm these findings due to the observational nature of most studies.
我们的目的是通过网状Meta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）治疗膀胱癌的可行性和安全性。
从包括PubMed/Medline、Embase、Cochrane图书馆和科学网在内的电子数据库中检索截至2019年8月符合条件的文章，无语言限制。研究的筛选、质量评估、数据提取和分析由两名独立的评审员（DCF和AL）使用Cochrane协作网的工具完成。
在筛选了2528篇文章后，最终的Meta分析纳入了27项研究。在网状Meta分析中，与ORC相比，RARC（MD：83.09，95%CI：61.06至105.11）和LRC（MD：49.68，95%CI：21.75至77.62）的手术时间更长。此外，RARC的手术时间比LRC长（MD：33.40，95%CI：1.35至65.45）。RARC（MD：-591.86，95%CI：-879.46至-304.27）和LRC（MD：-435.28，95%CI：-854.98至-15.58）的估计失血量（EBL）比ORC少；然而，RARC与LRC之间的EBL差异不显著。RARC（OR：0.26，95%CI：0.14至0.50）和LRC（OR：0.23，95%CI：0.13至0.43）的输血率比ORC高；然而，RARC与LRC之间的OR不显著。与ORC相比，RARC（MD：-1.34，95%CI：-2.55至-0.12）和LRC（MD：-1.35，95%CI：-2.38至-0.32）恢复正常饮食的时间更短；然而，RARC与LRC之间没有显著差异。与ORC相比，RARC（MD：-2.37，95%CI：-3.57至-1.17）和LRC（MD：-2.22，95%CI：-4.04至-0.40）的住院时间（LOS）更短；然而，RARC与LRC之间的LOS差异不显著。RARC、LRC和ORC在轻微并发症、严重并发症、手术切缘阳性和淋巴结收获方面具有可比性。
目前的证据表明，当由经验丰富的外科医生在选定的患者中进行时，微创方法可被视为ORC的一种可行且安全的替代方法。值得注意的是，RARC可能更适合于需要体外尿流改道的根治性膀胱切除术。由于大多数研究的观察性性质，仍需要更大规模、设计良好的试验来证实这些发现。
