Department of Urology, Xinyang Central Hospital, Xinyang, 464000, China Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Int J Surg. 2021 Oct;94:106137. doi: 10.1016/j.ijsu.2021.106137. Epub 2021 Sep 30.
To systematically review studies comparing the perioperative outcomes of intracorporeal robot-assisted radical cystectomy (iRARC) and open radical cystectomy (ORC).
Systematic searches of PubMed, Web of Science and the Cochrane Library were performed in June 2020. Studies with data comparing iRARC and ORC were included in our review, and a pooled meta-analysis was completed.
In total, 8 studies (7 prospective studies, 1 retrospective study) comparing 1193 patients were included for our review and meta-analysis. Compared with ORC, iRARC demonstrated lower estimated blood loss (weighted mean difference (WMD): -449.25; 95% CI -566.47 - -332.03; p < 0.01), lower blood transfusion rates (OR: 0.31; 95% CI 0.22 - 0.46; p < 0.01), and lower postoperative complication rates with Clavien-Dindo grades III-IV (30 days: OR: 0.65; 95% CI 0.47 - 0.90; p = 0.01; 90 days: OR: 0.72; 95% CI 0.53 - 0.98; p = 0.04), but a longer operative time (WMD: 78.82; 95% CI 52.77 - 104.87; P < 0.01). Furthermore, there was no significant difference between iRARC and ORC in terms of postoperative complication rates with Clavien-Dindo grades Ⅰ-Ⅱ (30 days: OR: 0.71; 95% CI 0.36 - 1.40; p = 0.32; 90 days: OR: 0.98; 95% CI 0.74 - 1.30; p = 0.89), length of stay (WMD: -1.18; 95% CI -3.33 - -2.07; p = 0.06) and positive surgical margins (OR: 0.78; 95% CI 0.0.45 - 1.36; p = 0.38).
iRARC was associated with a significantly lower estimated blood loss and a lower blood transfusion rate and major postoperative complication rate than ORC.
系统回顾比较经体内机器人辅助根治性膀胱切除术（iRARC）和开放性根治性膀胱切除术（ORC）围手术期结局的研究。
2020 年 6 月对 PubMed、Web of Science 和 Cochrane 图书馆进行了系统检索。纳入了比较 iRARC 和 ORC 的研究，并进行了荟萃分析。
共纳入 8 项研究（7 项前瞻性研究，1 项回顾性研究），对 1193 例患者进行了综述和荟萃分析。与 ORC 相比，iRARC 术中失血量明显减少（加权均数差（WMD）：-449.25；95%CI：-566.47-332.03；p<0.01），输血率较低（比值比（OR）：0.31；95%CI：0.220.46；p<0.01），术后 Clavien-Dindo 分级 III-IV 级并发症发生率较低（30 天：OR：0.65；95%CI：0.470.90；p=0.01；90 天：OR：0.72；95%CI：0.530.98；p=0.04），但手术时间较长（WMD：78.82；95%CI：52.77104.87；P<0.01）。此外，iRARC 与 ORC 术后 Clavien-Dindo 分级 I-II 级并发症发生率（30 天：OR：0.71；95%CI：0.361.40；p=0.32；90 天：OR：0.98；95%CI：0.741.30；p=0.89）、住院时间（WMD：-1.18；95%CI：-3.33-2.07；p=0.06）和阳性切缘（OR：0.78；95%CI：0.45~1.36；p=0.38）差异无统计学意义。
与 ORC 相比，iRARC 术中出血量明显减少，输血率和主要术后并发症发生率较低。
