Department of Urology, The Second Clinical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan, China.
J Endourol. 2021 Apr;35(4):473-482. doi: 10.1089/end.2020.0760. Epub 2020 Nov 12.
To summarize the current evidence on robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) and compare perioperative outcomes and postoperative complications of patients undergoing RARC with extracorporeal urinary diversion (ECUD) and ICUD. Through a systematical search of multiple scientific databases in March 2020, we performed a systematic review and cumulative meta-analysis of the primary outcomes of interest. Also, we assessed the quality of the relevant evidence according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. Thirteen studies with 4696 participants were included in this review. No significant differences were found between the ECUD and ICUD in operation time (OT) (mean difference [MD]: -6.45, 95% confidence interval [CI]: -35.20 to 22.30), length of stay (MD: 0.36, 95% CI: -0.81 to 1.54), 30-day overall complications (odds ratio [OR]: 0.92, 95% CI: 0.60-1.41), 30-day minor complications (OR: 1.36, 95% CI: 0.85-2.19), 30-day major complications (OR: 0.70, 95% CI: 0.34-1.43), 90-day overall complications (OR: 1.34, 95% CI: 0.83-2.18), and major complications (OR: 1.03, 95% CI: 0.68-1.57). However, less estimate blood loss (MD: 99.28 mL, 95% CI: 62.59-135.98), lower intraoperative blood transfusion (OR: 1.80, 95% CI: 1.09-2.95), shorter oral intake time (MD: 0.78, 95% CI: 0.43-1.14), and 90-day minor complications (OR: 1.72, 95% CI: 1.08-2.73) were associated with ICUD. The subgroup analysis showed less estimated blood loss (MD: 149.73, 95% CI: 21.33-278.13) and less OT (MD: 32.45, 95% CI: 14.37-50.53) were found in ICUD. The ICUD is a safe and feasible alternative to ECUD, which decreases the need for blood transfusion and reduces 90-day complications. However, further quality studies are needed to evaluate effectiveness of ICUD and its oncologic outcomes, functional outcomes, cost, and the quality of life.
总结机器人辅助根治性膀胱切除术（RARC）联合体内尿路分流术（ICUD）的现有证据，并比较 RARC 联合体外尿路分流术（ECUD）和 ICUD 的围手术期结果和术后并发症。我们于 2020 年 3 月通过系统搜索多个科学数据库，对主要研究结果进行了系统评价和累积荟萃分析。此外，我们根据 Cochrane 干预系统评价手册的框架评估了相关证据的质量。该综述纳入了 13 项研究共 4696 名参与者。ECUD 和 ICUD 之间的手术时间（OT）（平均差值 [MD]：-6.45，95%置信区间 [CI]：-35.20 至 22.30）、住院时间（MD：0.36，95%CI：-0.81 至 1.54）、30 天总体并发症（比值比 [OR]：0.92，95%CI：0.60-1.41）、30 天轻微并发症（OR：1.36，95%CI：0.85-2.19）、30 天主要并发症（OR：0.70，95%CI：0.34-1.43）、90 天总体并发症（OR：1.34，95%CI：0.83-2.18）和主要并发症（OR：1.03，95%CI：0.68-1.57）无显著差异。然而，ICUD 组术中失血量（MD：99.28ml，95%CI：62.59-135.98）、术中输血（OR：1.80，95%CI：1.09-2.95）、口服摄入时间（MD：0.78，95%CI：0.43-1.14）和 90 天轻微并发症（OR：1.72，95%CI：1.08-2.73）的估计值较低。亚组分析显示，ICUD 组术中失血量（MD：149.73，95%CI：21.33-278.13）和手术时间（MD：32.45，95%CI：14.37-50.53）较短。ICUD 是 ECUD 的一种安全且可行的替代方法，可减少输血需求并降低 90 天并发症的发生率。然而，需要进一步的高质量研究来评估 ICUD 的有效性及其肿瘤学结果、功能结果、成本和生活质量。
