Can robotic-assisted radical cystectomy provide patients with a smaller trauma and faster recovery period? A systematic review and meta-analysis of comparative trials

原文： 2020 年发布于 Cancer Treat Rev 20 卷第 4 期 22-35  浏览量：207次

作者： Peng L. Li J. Cao D. Ren Z. Wei T. You C. Cheng B. Wei Q. Li Y.

作者单位： Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia. claudia.rutherford@sydney.edu.au. Sydney Medical School, Discipline of Surgery, University of Sydney, Sydney, NSW, Australia. Department of Urology, Westmead Hospital, Westmead, NSW, Australia. Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia. Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Pain Management Research Institute, Royal North Shore Hospital, St Leonards, NSW, Australia. Sydney Medical School, Central Clinical School, University of Sydney, Sydney, NSW, Australia. Eastern Health Clinical School, Monash University, Box Hill, Vic, Australia. Department of Urology, Eastern Health, Box Hill, Vic, Australia. ANZUP Cancer Trials Group, Camperdown, NSW, Australia.

归属分类：膀胱肿瘤治疗及预后证据

DOI： 10.1016/j.clnu.2022.03.020

关键词： Cystectomy/*methods Humans Robotic Surgical Procedures/*methods Urinary Bladder Neoplasms/*surgery

OBJECTIVE: Minimally invasive surgical (MIS) approaches to radical cystectomy (RC) develop well in the past decades. We performed the present study to compare the perioperative outcomes, pathological outcomes, and oncologic outcomes between MIS approaches and open radical cystectomy (ORC) for bladder cancer. METHOD: We conducted a comprehensive study search up to March 2019, searching the online database Embase, PubMed and Cochrane Library. RESULTS: A total of 8 randomized controlled trials comprising 805 patients were included. We observed that MIS approaches were significantly associated with lower estimated blood loss (WMD = -343.21; 95%CI -431.34 to -255.08; P < 0.001), shorter length of stay (WMD = -0.76; 95%CI -1.28 to -0.24; P = 0.004), shorter time to flatus and diet (WMD = -0.46; 95%CI -0.64 to -0.27; P < 0.001; WMD = -0.92; 95%CI -1.58 to -0.28; P = 0.005; respectively), longer operation time (WMD = 61.38; 95%CI 34.89 to 87.88; P < 0.001), fewer 30-day overall complication (OR = 0.36; 95%CI 0.17 to 0.75; P = 0.007). And we did not detect significant difference in terms of 30-day (P = 0.278) and 90-day major complication (P = 0.899), positive surgical margins (P = 0.986), lymph node yield (P = 0.711), OS (P = 0.473), CSS (P = 0.778), RFS (P = 0.880), PFS (P = 0.324) between MIS approaches and ORC. CONCLUSION: In the present studies, we demonstrated that MIS approaches improved perioperative outcomes and had similar pathological and oncological outcomes compared with ORC. Stratified by type of MIS approaches, the results are similar. In conclusion, MIS approaches could serve as an alternative choice in patients with bladder cancer. However, long-term clinical outcomes highlight the need for future studies.