Department of Urology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, China.
Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, 730030, Gansu, China.
Surg Endosc. 2024 Sep;38(9):5041-5052. doi: 10.1007/s00464-024-11074-5. Epub 2024 Jul 15.
To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer.
A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522).
The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD - 45.69, 95% CI - 78.91 ~ - 12.47, p = 0.007, and MD - 0.69, 95% CI - 1.25 ~ - 0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival.
ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.
评估保留生殖器官的根治性膀胱切除术（ROPRC）与标准根治性膀胱切除术（SRC）在女性膀胱癌治疗中的围手术期、肿瘤学和功能结局。
2023 年 11 月，我们在多个科学数据库中进行了系统搜索。我们根据 PRISMA 和 AMSTAR 指南对主要研究结果进行了系统评价和累积荟萃分析。该研究已在 PROSPERO（CRD42024501522）中注册。
荟萃分析纳入了 10 项共 2015 名参与者的研究。与 SRC 相比，ROPRC 显示手术时间和术后禁食期明显缩短（MD -45.69，95%CI -78.91-12.47，p=0.007 和 MD -0.69，95%CI -1.25-0.13，p=0.02）。功能结局，日间控尿率（OR 4.94，95%CI 1.5315.91，p=0.008）和夜间控尿率（OR 5.91，95%CI 1.9418.01，p=0.002），以及女性性功能指数（Female Sexual Function Index，FSFI）评估的性功能（MD 5.72，95%CI 0.19~11.26，p=0.04）在 ROPRC 组均有显著改善。在估计失血量、住院时间、总体术后并发症、轻微并发症或主要并发症方面，ROPRC 与 SRC 之间无显著差异。在肿瘤学方面，两种手术均具有相似的结果，在阳性切缘、肿瘤复发率、总生存率、癌症特异性生存率、无复发生存率或无进展生存率方面无显著差异。
ROPRC 是女性膀胱癌患者的一种可行且有效的替代方案，可改善功能结局并具有相似的肿瘤安全性。这些发现表明，ROPRC 可以提高女性膀胱癌患者的生活质量，同时不影响癌症治疗的疗效。
