Chen Yushui, Fan Gen, Wu Yinyu, Wang Yu, Cai Songzhi, Li Yang, Tang Tielong
Department of Urology/School of Clinical Medicine, North Sichuan Medical College/Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Shunqing District, Nanchong, 63700, Sichuan, China.
J Robot Surg. 2025 May 6;19(1):200. doi: 10.1007/s11701-025-02349-7.
This study compared the perioperative outcomes of ECUD and ICUD after robot-assisted radical cystectomy for bladder cancer by systematic review and meta-analysis. Our study was registered in PROSPERO, (CRD420250655207). A search strategy was constructed based on PICO principles and subject term extensions (Mesh Term and Emtree), and 149 publications were retrieved in in Pubmed, Web of Science, Embase and Cochrane Library. The literature was screened by two researchers using Endnote following the PROSPERO process and inclusion-exclusion criteria, and four studies were retained. In total, 975 patients with ECUD and 419 patients with ICUD were included. Baseline levels were assessed using the Fixed Mantel-Haenszel method and Random I-V heterogeneit. The patient's condition is consistent. The quality of the retained cohort study articles was assessed using the New Castle Ottawa Scale (NOS). All 4 studies were of high quality. Perioperative outcomes included blood loss, time to urethral diversion, overall operative time, length of stay, number of 90 day readmissions, number of early major complications, number of 90 day complications, and number of early complications. Data were transformed using RevMan 5.4 and means and standard deviations were estimated. Data were transformed and statistically analysed using StataMP 16, with continuous variables assessed using standardised mean difference (SMD) and 95% confidence intervals (CI), and categorical variables assessed using odds ratios (OR) and 95%CIs, with heterogeneity and sensitivity analyses. Robot-assisted radical cystectomy for bladder cancer after ECUD resulted in shorter overall operative time and urethral diversion time compared to ICUD, with mean reductions of 93.54 and 36.85 min, respectively. Early complications were more in ECUD compared to ICUD. There was no difference in blood loss, length of hospital stay, 90 day rehospitalisation, early major complications, or early complications.
本研究通过系统评价和荟萃分析，比较了机器人辅助根治性膀胱切除术后回肠原位新膀胱术（ECUD）和回肠导管术（ICUD）的围手术期结局。我们的研究已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD420250655207）登记。基于PICO原则和主题词扩展（医学主题词表和Emtree）构建了检索策略，在PubMed、科学网、Embase和Cochrane图书馆中检索到149篇出版物。两名研究人员按照PROSPERO流程和纳入排除标准，使用Endnote对文献进行筛选，最终保留了四项研究。总共纳入了975例行ECUD的患者和419例行ICUD的患者。使用固定Mantel-Haenszel方法和随机I-V异质性方法评估基线水平。患者情况一致。使用纽卡斯尔渥太华量表（NOS）评估保留的队列研究文章的质量。所有四项研究均为高质量。围手术期结局包括失血量、尿道改道时间、总手术时间、住院时间、90天再入院次数、早期严重并发症次数、90天并发症次数和早期并发症次数。使用RevMan 5.4对数据进行转换，并估计均值和标准差。使用StataMP 16对数据进行转换和统计分析，连续变量使用标准化均值差（SMD）和95%置信区间（CI）进行评估，分类变量使用比值比（OR）和95%CI进行评估，并进行异质性和敏感性分析。与ICUD相比，膀胱癌机器人辅助根治性膀胱切除术后行ECUD的患者总手术时间和尿道改道时间更短，平均分别减少了93.54分钟和36.85分钟。与ICUD相比，ECUD的早期并发症更多。在失血量、住院时间、90天再次住院、早期严重并发症或早期并发症方面没有差异。
