Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China.
Department of Urology, Yuzhou People's Hospital, Xuchang, China.
Int J Clin Pract. 2021 Oct;75(10):e14639. doi: 10.1111/ijcp.14639. Epub 2021 Aug 4.
We performed a meta-analysis to evaluate the effects of open nephroureterectomy compared with laparoscopic nephroureterectomy on postoperative results in upper urinary tract urothelial carcinoma subjects.
A systematic literature search up to January 2021 was done and 36 studies included 23 013 subjects with upper urinary tract urothelial carcinoma at the start of the study; 8178 of them were laparoscopic nephroureterectomy, and 14 835 of them were open nephroureterectomy. They were reporting relationships between the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma using the dichotomous or continuous method with a random or fixed-effect model.
Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma was significantly related to longer operation time (MD, 43.90; 95% CI, 20.91-66.90, P < .001), shorter hospital stay (MD, -1.71; 95% CI, -2.42 to -1.00, P < .001), lower blood loss (MD, -133.82; 95% CI, -220.92 to -46.73, P = .003), lower transfusion need (OR, 0.56; 95% CI, 0.47-0.67, P < .001) and lower overall complication (OR, 0.79; 95% CI, 0.70-0.90, P < .001) compared with open nephroureterectomy. However, no significant difference was found between laparoscopic nephroureterectomy and open nephroureterectomy in subjects with upper urinary tract urothelial carcinoma in 2-5-years recurrence-free survival (OR, 0.90; 95% CI, 0.69-1.18, P = .46), 2-5-years cancer-specific survival (OR, 0.94; 95% CI, 0.69-1.28, P = .68) and 2-5-years overall survival (OR, 1.31; 95% CI, 0.91-1.87, P = .15).
Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma may have a longer operation time, shorter hospital stay, lower blood loss, transfusion need and overall complication compared with open nephroureterectomy. Further studies are required to validate these findings.
我们进行了一项荟萃分析，以评估开放式输尿管切除术与腹腔镜输尿管切除术在上尿路尿路上皮癌患者术后结果方面的影响。
系统检索至 2021 年 1 月，并纳入 36 项研究，共 23013 例上尿路尿路上皮癌患者，其中 8178 例为腹腔镜输尿管切除术，14835 例为开放式输尿管切除术。这些研究报告了开放式输尿管切除术与腹腔镜输尿管切除术在治疗上尿路尿路上皮癌的疗效和安全性方面的关系。我们使用二项或连续方法，以随机或固定效应模型，计算比值比（OR）或均数差（MD）及其 95%置信区间（CI），以评估开放式输尿管切除术与腹腔镜输尿管切除术在上尿路尿路上皮癌治疗中的疗效和安全性。
与开放式输尿管切除术相比，腹腔镜输尿管切除术在上尿路尿路上皮癌患者中具有明显更长的手术时间（MD，43.90；95%CI，20.91-66.90，P<0.001）、更短的住院时间（MD，-1.71；95%CI，-2.42 至-1.00，P<0.001）、更少的出血量（MD，-133.82；95%CI，-220.92 至-46.73，P=0.003）、更低的输血需求（OR，0.56；95%CI，0.47-0.67，P<0.001）和更低的总并发症发生率（OR，0.79；95%CI，0.70-0.90，P<0.001）。然而，在 2-5 年无复发生存率（OR，0.90；95%CI，0.69-1.18，P=0.46）、2-5 年癌症特异性生存率（OR，0.94；95%CI，0.69-1.28，P=0.68）和 2-5 年总生存率（OR，1.31；95%CI，0.91-1.87，P=0.15）方面，腹腔镜输尿管切除术与开放式输尿管切除术在上尿路尿路上皮癌患者中没有显著差异。
与开放式输尿管切除术相比，腹腔镜输尿管切除术在上尿路尿路上皮癌患者中可能具有更长的手术时间、更短的住院时间、更少的出血量、输血需求和总并发症发生率。需要进一步的研究来验证这些发现。
