Maibom Sophia Liff, Joensen Ulla Nordström, Poulsen Alicia Martin, Kehlet Henrik, Brasso Klaus, Røder Martin Andreas
Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark.
BMJ Open. 2021 Apr 14;11(4):e043266. doi: 10.1136/bmjopen-2020-043266.
To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these.
Systematic review.
The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale.
The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC.
Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC.
研究膀胱癌根治性膀胱切除术（RC）后的短期（<90天）发病率和死亡率，并确定与之相关的可改变风险因素。
系统评价。
按照系统评价和Meta分析的首选报告项目指南进行系统评价。于2019年6月11日在PubMed和EMBASE上检索相关论文，并于2020年5月27日重新检索。纳入报告90天内并发症、再次手术、住院时间和死亡率的研究。根据牛津循证医学中心的标准对研究进行综述，并使用纽卡斯尔-渥太华量表评估证据质量。
检索到1957篇文章。纳入66篇文章。证据质量从差到好。大多数研究为回顾性研究，未识别出随机临床试验。纳入研究中，术后并发症报告的马丁标准中位数为6条。并发症分级最常使用Clavien-Dindo分类法。RC术后院内并发症加权总发生率为34.9%（范围28.8 - 68.8），30天并发症发生率为39.0%（范围27.3 - 80.0），90天并发症发生率为58.5%（范围36.1 - 80.5）。报告的最常见并发症类型为胃肠道（29.0%）和感染性（26.4%）。院内死亡率加权发生率为2.4%（范围0.9 - 4.7），30天死亡率为2.1%（0.0 - 3.7），90天死亡率为4.7%（范围0.0 - 7.0）。年龄和合并症被确定为RC术后并发症的最佳预测因素。
RC术后短期发病率和死亡率较高。并发症报告存在异质性，证据质量普遍较低。持续需要进行随机研究以探讨任何可降低RC术后发病率和死亡率的干预措施。
PROSPERO注册号：104937。
