Cao Lin, Huang Li-Ge, Zhang Li-Hao, Yang Gang, Li Jia-Bing
North Sichuan Medical College, Nanchong, China.
The First People's Hospital of Mian Yang, Mianyang, China.
J Robot Surg. 2025 Mar 10;19(1):106. doi: 10.1007/s11701-025-02268-7.
Recent studies have highlighted the progress of robotic-assisted radical cystectomy (RARC), yet information on intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD), especially in elderly patients, remains limited. This review seeks to address this gap in the literature. A systematic literature review was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases, following the PRISMA guidelines. Studies comparing ICUD to ECUD in patients aged ≥ 65 years. We combined the data using weighted mean differences (WMD) or odds ratios (OR) with random-effects models. For results showing moderate-to-high heterogeneity, a sensitivity analysis was performed by sequentially excluding individual studies. Nine studies comprising 4340 patients (1967 in ICUD and 2373 in ECUD) were included in the meta-analysis. ICUD was associated with significantly lower estimated blood loss (WMD: - 64.34 mL, 95% CI: - 113.26, - 15.42, P = 0.01), reduced blood transfusion rates (OR: 0.29, 95% CI: 0.11, 0.76, P = 0.01), and fewer overall gastrointestinal complications (OR: 0.65, 95% CI: 0.46, 0.92, P = 0.016) compared to ECUD in patients aged 65 and older. No significant differences were found in operative duration, length of hospitalization, or 30-day/90-day complication and readmission rates. Sensitivity analysis indicated low evidence for outcomes such as blood loss and transfusion rates. Overall, elderly patients undergoing RARC may benefit from ICUD in terms of reduced blood loss, lower blood transfusion rates, and fewer gastrointestinal complications. However, large prospective randomized studies are still required to confirm these findings.
近期研究突显了机器人辅助根治性膀胱切除术（RARC）的进展，但关于体内尿流改道术（ICUD）和体外尿流改道术（ECUD）的信息，尤其是在老年患者中，仍然有限。本综述旨在填补文献中的这一空白。按照PRISMA指南，在PubMed、Embase、科学网和考克兰图书馆数据库中进行了系统的文献综述。纳入了比较年龄≥65岁患者的ICUD与ECUD的研究。我们使用加权平均差（WMD）或比值比（OR）以及随机效应模型合并数据。对于显示中度至高异质性的结果，通过依次排除个别研究进行敏感性分析。荟萃分析纳入了9项研究，共4340例患者（ICUD组1967例，ECUD组2373例）。与65岁及以上患者的ECUD相比，ICUD与显著更低的估计失血量（WMD：-64.34 mL，95%CI：-113.26，-15.42，P = 0.01）、更低的输血率（OR：0.29，95%CI：0.11，0.76，P = 0.01）以及更少的总体胃肠道并发症（OR：0.65，95%CI：0.46，0.92，P = 0.016）相关。在手术时间、住院时长或30天/90天并发症及再入院率方面未发现显著差异。敏感性分析表明，失血量和输血率等结果的证据强度较低。总体而言，接受RARC的老年患者在减少失血量、降低输血率和减少胃肠道并发症方面可能从ICUD中获益。然而，仍需要大型前瞻性随机研究来证实这些发现。
