Zhang Yi, Peng Lei, Zhang Yang, Li Hangxu, Li Songbei, Zhang Shaohua, Shi Jianguo
Department of Urology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, Liaoning, China.
Department of Urology, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou Medical University, Jinzhou, Liaoning, China.
PeerJ. 2024 Nov 27;12:e18427. doi: 10.7717/peerj.18427. eCollection 2024.
The clinical safety and efficacy of organ-sparing cystectomy (OSC) are subjects of ongoing debate, particularly concerning the potential increased risk of recurrence when retaining additional organs and its effectiveness in preserving sexual and urinary functions.
Adhering to the PRISMA 2020 statement and AMSTAR Guidelines, we conducted a systematic literature search up to February 2024 using PubMed, Embase, and Web of Science. The comparison focused on the clinical safety and effectiveness of OSC and standard radical cystectomy (SRC) in the treatment of bladder tumors. Our assessment covered several dimensions: Surgical safety outcomes (operation time, length of stay (LOS), estimated blood loss (EBL), and complications), oncological safety outcomes (recurrence rate, positive surgical margin rate, overall survival, and cancer-specific survival), and functional efficacy outcomes (daytime and nighttime urinary incontinence at 6 and 12 months, clean intermittent catheterization (CIC) rate, and erectile function within and after 1 year).
The analysis included 19 eligible studies, encompassing 2,057 patients (1,189 OSC patients and 768 SRC patients). OSC demonstrated significant benefits in terms of erectile function and urinary continence without impacting CIC rates. No significant differences were observed in recurrence rate, positive surgical margin rate, overall survival, and cancer-specific survival. Furthermore, OSC and SRC were comparable in surgical safety outcomes, including operating time, LOS, EBL, and complications.
OSC offers notable advantages in erectile function and urinary continence. Despite limited clinical practice and potential selection bias, urologists may still consider OSC more based on their experience and specific patient factors.
保留器官的膀胱切除术（OSC）的临床安全性和有效性一直是争论的焦点，特别是在保留额外器官时复发风险可能增加以及其在保留性功能和排尿功能方面的有效性。
遵循PRISMA 2020声明和AMSTAR指南，我们截至2024年2月使用PubMed、Embase和Web of Science进行了系统的文献检索。比较重点在于OSC和标准根治性膀胱切除术（SRC）在治疗膀胱肿瘤方面的临床安全性和有效性。我们的评估涵盖几个维度：手术安全结果（手术时间、住院时间（LOS）、估计失血量（EBL）和并发症）、肿瘤学安全结果（复发率、手术切缘阳性率、总生存率和癌症特异性生存率）以及功能疗效结果（6个月和12个月时的日间和夜间尿失禁、清洁间歇性导尿（CIC）率以及1年内和1年后的勃起功能）。
分析纳入了19项符合条件的研究，涉及2057例患者（1189例OSC患者和768例SRC患者）。OSC在勃起功能和尿失禁方面显示出显著益处，且不影响CIC率。在复发率、手术切缘阳性率、总生存率和癌症特异性生存率方面未观察到显著差异。此外，OSC和SRC在手术安全结果方面具有可比性，包括手术时间、LOS、EBL和并发症。
OSC在勃起功能和尿失禁方面具有显著优势。尽管临床实践有限且存在潜在的选择偏倚，但泌尿外科医生仍可能根据自身经验和特定患者因素更多地考虑OSC。
