Luo Jin, Guo Lang, Fan Jie, Chen Li, Zhou Jie
Department of Urology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, Hubei, People's Republic of China.
Hubei University of Traditional Chinese Medicine, Wuhan, 430061, Hubei, People's Republic of China.
J Robot Surg. 2025 Apr 22;19(1):168. doi: 10.1007/s11701-025-02323-3.
The focus of this comprehensive review and meta-analysis is to evaluate both the efficacy and safety of robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in treating bladder cancer among elderly patients. A rigorous review of literature utilized several key databases-Google Scholar, the Cochrane Library, EMBASE, PubMed, and the Web of Science, complete with updates through July 2024. The data were analyzed using Stata 18, employing a random-effects model for the analysis. In this analysis, five studies were analyzed. Initial comparisons revealed that age, body mass index (BMI), and pT3 staging were consistent across both groups, with gender being the only exception showing variation. The results demonstrated that patients undergoing robot-assisted cystectomy had reduced estimated blood loss, decreased duration of hospitalization, and fewer instances of positive surgical margins. The analysis found no notable statistical discrepancies in operative durations between the two groups, transfusion rate, overall complications, minor complications, major complications, or lymph node positivity rates. In terms of urinary diversion, ileal conduit was more common in the RARC group, while ureterocutaneostomy was more frequently observed in the ORC group. However, no significant differences were found between the two groups regarding the use of orthotopic neobladder. RARC offers a viable and secure approach for surgical treatment in elderly patients with bladder cancer, showing potential enhancements in crucial areas such as reduced estimated blood loss and shorter durations of hospitalization.
本综述和荟萃分析的重点是评估机器人辅助根治性膀胱切除术（RARC）与开放性根治性膀胱切除术（ORC）在老年膀胱癌患者治疗中的疗效和安全性。通过对多个关键数据库（谷歌学术、考克兰图书馆、EMBASE、PubMed和科学网）进行严格的文献检索，并更新至2024年7月。使用Stata 18软件进行数据分析，采用随机效应模型进行分析。本分析纳入了五项研究。初步比较显示，两组患者的年龄、体重指数（BMI）和pT3分期一致，唯一不同的是性别存在差异。结果表明，接受机器人辅助膀胱切除术的患者估计失血量减少、住院时间缩短，手术切缘阳性的情况也较少。分析发现，两组在手术时间、输血率、总体并发症、轻微并发症、严重并发症或淋巴结阳性率方面没有显著的统计学差异。在尿流改道方面，回肠膀胱术在RARC组中更为常见，而输尿管皮肤造口术在ORC组中更为常见。然而，两组在原位新膀胱的使用方面没有发现显著差异。RARC为老年膀胱癌患者的手术治疗提供了一种可行且安全的方法，在减少估计失血量和缩短住院时间等关键方面显示出潜在的优势。
