Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials.

Autor: Khetrapal P; Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, Barts Health NHS Trust, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: p.khetrapal@ucl.ac.uk., Wong JKL; Department of Anaesthetics, Homerton University Hospital NHS Foundation Trust, London, UK; London School of Hygiene and Tropical Medicine, London, UK., Tan WP; Department of Urology, NYU Langone Health, New York, NY, USA., Rupasinghe T; Division of Surgery & Interventional Sciences, University College London, London, UK., Tan WS; Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Williams SB; Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA., Boorjian SA; Department of Urology, Mayo Clinic, Rochester, Minnesota, MN, USA., Wijburg C; Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands., Parekh DJ; Desai Sethi Urology Institute at the Miller School of Medicine, University of Miami, Miami, FL, USA., Wiklund P; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Vasdev N; Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK; School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK., Khan MS; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK., Guru KA; Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Catto JWF; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Kelly JD; Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
Jazyk: angličtina
Zdroj: European urology [Eur Urol] 2023 Oct; Vol. 84 (4), pp. 393-405. Date of Electronic Publication: 2023 May 09.
DOI: 10.1016/j.eururo.2023.04.004
Abstrakt: Context: Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
Objective: This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures.
Evidence Acquisition: Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022.
Evidence Synthesis: Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03-0.39, p = 0.02) than and similar complication rates to ORC. ORC was associated with higher thromboembolic events (odds ratio [OR] 1.84, 95% CI 1.02-3.31, p = 0.04). ORC was associated with more blood loss (MD 322 ml, 95% CI 193-450, p < 0.001) and transfusions (OR 2.35, 95% CI 1.65-3.36, p < 0.001), but shorter operative time (MD 76 min, 95% CI 39-112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI -1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54-1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29-0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4-15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients.
Conclusions: RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events.
Patient Summary: This study compares robot-assisted keyhole surgery with open surgery for bladder cancer. The robot-assisted approach offered less blood loss, shorter hospital stays, and fewer blood clots. No other differences were seen.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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