冷冻消融与机器人辅助部分肾切除术治疗 cT1 期肾肿瘤的疗效比较：系统评价和荟萃分析。
Comparative efficacy of cryoablation versus robot-assisted partial nephrectomy in the treatment of cT1 renal tumors: a systematic review and meta-analysis.
机构信息
Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China.
Department of Clinical Medicine, North Sichuan Medical College, No. 234 Fujiang Road Shunqing, Nanchong, Sichuan, 637000, P.R. China.
出版信息
BMC Cancer. 2024 Sep 16;24(1):1150. doi: 10.1186/s12885-024-12917-z.
PURPOSE
This study utilizes a meta-analytic approach to investigate the effects of cryoablation and robot-assisted partial nephrectomy on perioperative outcomes, postoperative renal function, and oncological results in patients.
METHODS
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to November 2023. The primary outcomes were perioperative results, complications, postoperative renal function and oncologic outcomes. Review Manager 5.4 was used for this analysis.
RESULTS
This study included a total of 10 studies comprising 2,011 patients. Compared to RAPN (Robot-Assisted Partial Nephrectomy), the CA (Cryoablation) group had a shorter hospital stay [MD -1.76 days; 95% CI -3.12 to -0.41; p = 0.01], less blood loss [MD -104.60 ml; 95% CI -152.58 to -56.62; p < 0.0001], and fewer overall complications [OR 0.62; 95% CI 0.45 to 0.86; p = 0.004], but a higher recurrence rate [OR 7.83; 95% CI 4.32 to 14.19; p < 0.00001]. There were no significant differences between the two groups in terms of operative time, minor complications (Clavien-Dindo Grade 1-2), major complications (Clavien-Dindo Grade 3-5), changes in renal function at 12 months post-operation, RFS (Recurrence-Free Survival), and OS (Overall Survival).
CONCLUSION
The evidence provided by this meta-analysis indicates that the therapeutic effects of Cryoablation (CA) are similar to those of Robot-Assisted Partial Nephrectomy (RAPN) in terms of perioperative outcomes and renal function. However, the recurrence rate of tumors treated with CA is significantly higher.
SYSTEMATIC REVIEW REGISTRATION
The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023465846).
目的
本研究采用荟萃分析方法，探讨冷冻消融和机器人辅助部分肾切除术对患者围手术期结局、术后肾功能和肿瘤学结果的影响。
方法
本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）声明。系统检索了四个电子数据库（PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库），以确定截至 2023 年 11 月发表的英文相关研究。主要结局是围手术期结果、并发症、术后肾功能和肿瘤学结果。使用 Review Manager 5.4 进行分析。
结果
本研究共纳入 10 项研究，共计 2011 例患者。与 RAPN（机器人辅助部分肾切除术）相比，CA（冷冻消融）组的住院时间更短[MD -1.76 天；95%CI -3.12 至 -0.41；p=0.01]，出血量更少[MD -104.60ml；95%CI -152.58 至 -56.62；p<0.0001]，总体并发症更少[OR 0.62；95%CI 0.45 至 0.86；p=0.004]，但复发率更高[OR 7.83；95%CI 4.32 至 14.19；p<0.00001]。两组在手术时间、轻度并发症（Clavien-Dindo 分级 1-2）、重度并发症（Clavien-Dindo 分级 3-5）、术后 12 个月肾功能变化、RFS（无复发生存率）和 OS（总体生存率）方面无显著差异。
结论
本荟萃分析提供的证据表明，冷冻消融（CA）的治疗效果在围手术期结果和肾功能方面与机器人辅助部分肾切除术（RAPN）相似，但 CA 治疗的肿瘤复发率明显更高。
系统评价注册
该研究已在国际前瞻性系统评价注册库（PROSPERO：CRD42023465846）注册。
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