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Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis.The Journal of Urology Apr 2019We performed an updated systematic review and meta-analysis of outcomes important to patients in those undergoing robot-assisted and open radical cystectomy. (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
We performed an updated systematic review and meta-analysis of outcomes important to patients in those undergoing robot-assisted and open radical cystectomy.
MATERIALS AND METHODS
Multiple scientific databases were searched up to July 2018 for randomized, controlled trials comparing robot-assisted and open radical cystectomy. The primary outcomes of interest were disease progression, major (Clavien III-V) complications and 90-day quality of life. The quality of evidence was evaluated according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS
Five studies with a total of 540 participants were included in this review. There was no difference between robot-assisted and open radical cystectomy in disease progression (RR 0.94, 95% CI 0.69-1.29), major complications (RR 1.06, 95% CI 0.75-1.49) or quality of life (standardized mean difference -0.03, 95% CI -0.27-0.21). However, robot-assisted radical cystectomy demonstrated a reduced risk of perioperative blood transfusion (RR 0.58, 95% CI 0.43-0.80) and a marginally shorter hospital stay (RR -0.63 days, 95% CI -1.21-0.05). Operative time was longer in the robot-assisted group (mean difference 68.51 minutes, 95% CI 30.55-105.48). There was no statistically significant difference in local recurrence rates between the procedures (RR 2.08, 95% CI 0.96-4.50) but this difference may be clinically significant and it favored open radical cystectomy. The overall quality of evidence was judged to be moderate.
CONCLUSIONS
Surgical approach does not have a considerable impact on oncologic, safety and quality of life outcomes in patients who undergo radical cystectomy. The benefits conferred by robot-assisted radical cystectomy are a decreased need for blood transfusion and earlier hospital discharge.
Topics: Cystectomy; Humans; Robotic Surgical Procedures; Treatment Outcome
PubMed: 30321551
DOI: 10.1016/j.juro.2018.10.006 -
Actas Urologicas Espanolas Jun 2023Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs ORC.
METHODS
A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs ORC.
RESULTS
A total of eight RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI 83.83-100.84, p<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI 0.30-0.61, p<0.001). No differences emerged in terms of 90-day overall (p=0.28) and major (p=0.57) complications, length of stay (p=0.18), bowel recovery (p=0.67), health-related quality of life (p=0.86), disease recurrence (p=0.77) and progression (p=0.49) between the two approaches. The main limitation is represented by the low number of patients included in half of RCTs included.
CONCLUSIONS
This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure.
Topics: Humans; Cystectomy; Robotics; Robotic Surgical Procedures; Postoperative Complications; Treatment Outcome; Neoplasm Recurrence, Local; Randomized Controlled Trials as Topic
PubMed: 36737037
DOI: 10.1016/j.acuroe.2023.01.003 -
Annals of Surgical Oncology Sep 2023This study aimed to compare perioperative and oncologic outcomes of extraperitoneal radical cystectomy (EPRC) and transperitoneal radical cystectomy (TPRC). (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aimed to compare perioperative and oncologic outcomes of extraperitoneal radical cystectomy (EPRC) and transperitoneal radical cystectomy (TPRC).
METHODS
A systematical search of multiple scientific databases was performed in September 2022. The systematic review and cumulative meta-analysis of the primary outcomes of interest were performed according to the PRISMA and AMSTAR guidelines and registered in the PROSPERO database (PROSPERO [CRD42022359322]).
RESULTS
The review and analysis included eight studies with 989 participants. No significant differences were found between EPRC and TPRC in terms of operation time, estimated blood loss (EBL), hospital length of stay (LOS), or transfusion. A shorter exhaust time (standardized mean difference [SMD] - 0.59; 95 % confidence interval [CI] - 0.97 to 0.21; p = 0.002) and time to liquid intake (SMD, - 0.56; 95 % CI - 1.07 to 0.04; p = 0.03) were associated with EPRC. No clinically meaningful difference was observed in terms of postoperative infection, wound complications, postoperative genitourinary complications, late postoperative complications, early major complications, or late major complications. However, EPRC was related to lower incidences of early postoperative complications (odds ratio [OR], 0.66; 95 % CI 0.51-0.86; p = 0.002), gastrointestinal complications (OR 0.28; 95 % CI 0 0.17-0.46; p < 0.00001), and postoperative ileus (OR 0.38; 95 % CI 0.25-0.59; p < 0.0001). A higher incidence of postoperative lymphocele was associated with EPRC (OR 3.05; 95 % CI 1.13-8.25; p = 0.03). No clinically meaningful difference was found in terms of positive surgical margin (PSM), local recurrence, distant metastasis, or OS.
CONCLUSIONS
Although EPRC had a higher incidence of lymphoceles than TPRC, it was found to have similar oncologic outcomes and fewer early complications, particularly in terms of postoperative gastrointestinal complications and ileus. These results suggest that EPRC is a safe option both functionally and oncologically.
Topics: Humans; Cystectomy; Urinary Bladder; Urinary Bladder Neoplasms; Ileus; Postoperative Complications; Robotic Surgical Procedures; Treatment Outcome
PubMed: 37344747
DOI: 10.1245/s10434-023-13744-5 -
Fertility and Sterility Dec 2022To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Patients with endometriomas undergoing cystectomy or ablation.
INTERVENTION(S)
All prospective studies comparing cystectomy with ablation for endometrioma in the PubMed, EMBASE, MEDLINE and Web of Science until April 3, 2022 were retrieved and reviewed. Medical treatment used as adjuvant therapy for the surgery was excluded. Two authors assessed eligibility and risk of bias independently. The statistical data were pooled using the Review Manager software.
MAIN OUTCOME MEASURE(S)
The changes of AMH levels and AFC values in cystectomy group and ablation group, including intergroup comparisons and intragroup comparisons.
RESULT(S)
Four randomized clinical trials and 2 prospective cohort studies were eligible for the meta-analysis, with a total of 294 patients. In the intergroup comparisons, preoperative AFC values were similar with low heterogeneity, but postoperative AFC values were significantly lower in cystectomy than ablation (mean differences [MD], -1.33; 95% credible interval, -2.15 to -0.51; I = 57%). In the intragroup comparisons of AFC values, sensitivity analyses showed a significant decrease in cystectomy (MD, -1.93; 95% credible interval, -2.40 to -1.45; I = 0%) at 6-month follow-up, compared with no reduction in ablation. The intragroup comparisons of AMH levels supported negative effects on ovarian reserve of both cystectomy (MD, -1.26; 95% credible interval, -1.64 to -0.88; I = 45%) and ablation (MD, -0.70; 95% credible interval, -1.07 to -0.32; I = 0%).
CONCLUSION(S)
Both ablation and cystectomy have significantly detrimental effects on ovarian reserve as evaluated by AMH, but the ablation causes relatively less damage to ovarian reserve as appraised by AFC.
CLINICAL TRIAL REGISTRATION NUMBER
CRD42020152823;PROSPERO (york.ac.uk).
Topics: Female; Humans; Ovarian Reserve; Prospective Studies; Laparoscopy; Endometriosis; Anti-Mullerian Hormone
PubMed: 36334993
DOI: 10.1016/j.fertnstert.2022.08.860 -
Hernia : the Journal of Hernias and... Apr 2017The natural history of development of Parastomal hernia (PH) following cystectomy and ileal conduit diversion is poorly understood. The aim of this study was to... (Review)
Review
PURPOSE
The natural history of development of Parastomal hernia (PH) following cystectomy and ileal conduit diversion is poorly understood. The aim of this study was to systematically review the frequency and risk factors of PH following ileal conduit diversion.
METHODS
A systematic review of literature was performed and the Cochrane, EMBASE and PubMed databases were searched from 1 January 1985 to 30th April 2016. All articles reporting occurrence of PH following cystectomy and ileal conduit diversion were analysed. The primary outcome measure was the frequency of development of PH. Secondary outcome measures were risk factors for PH development, complications of PH, frequency of PH repair and recurrence of PH.
RESULTS
Twelve articles of the 63 originally identified were analysed. Sample sizes ranged from 36 to 1057 patients with a pooled total of 3170 undergoing ileal conduit surgery. Age at the time of surgery ranged from 31 to 92 years. Of the 3170 patients who underwent ileal conduit surgery, 529 patients (17.1%) developed a PH based on either clinical examination or cross sectional imaging. Female gender, high BMI, low preoperative albumin and previous laparotomy were significantly associated with the development of PH in two studies. Repair of PH was offered to 8-75% of patients. The rate of recurrence following repair of PH was reported to range from 27 to 50%.
CONCLUSION
A PH is frequent following cystectomy and ileal conduit urinary diversion. The diagnosis of a PH depends upon duration of clinical follow-up and the use of cross-sectional imaging. The recurrence rates following the repair of a PH remain substantial.
Topics: Cystectomy; Hernia, Ventral; Humans; Ileostomy; Risk Factors; Urinary Bladder Neoplasms; Urinary Diversion
PubMed: 28025739
DOI: 10.1007/s10029-016-1561-z -
European Urology Focus Aug 2015Cigarette smoking is an established risk factor for urothelial carcinoma. (Review)
Review
CONTEXT
Cigarette smoking is an established risk factor for urothelial carcinoma.
OBJECTIVE
To elucidate the association between pretreatment smoking status, cumulative exposure, and time since smoking cessation and the development of and outcomes for urothelial carcinoma of the bladder (UCB) in patients treated with transurethral resection of the bladder (TURBT) or radical cystectomy (RC).
EVIDENCE ACQUISITION
A literature search was performed in September 2014 using the PubMed and Scopus databases limited to articles published in English since 1990. Eight contemporary studies on smoking and UBC development and 26 studies on smoking and UBC prognosis met the inclusion criteria.
EVIDENCE SYNTHESIS
Current cigarette smoking increases the risk of UCB incidence by two to fourfold, while smoking cessation attenuates this risk. Smoking status, exposure, and cessation have an evident impact on disease recurrence for patients who undergo TURBT, with weaker associations between smoking and other endpoints for TURBT and RC patients.
CONCLUSION
Retrospective evidence suggests that smoking markedly increases UCB risk and may lead to unfavorable outcomes for patients who already have UCB; smoking cessation can attenuate these undesirable effects.
PATIENT SUMMARY
Current evidence proves that cigarette smoking is an established risk factor for the development of urothelial carcinoma of the bladder (UCB). There is a growing body of evidence that smoking negatively affects outcomes for UCB patients treated with transurethral resection and/or radical cystectomy, although not uniformly. Long-term smoking cessation seems to mitigate the detrimental effects of smoking in non-muscle-invasive and muscle-invasive bladder cancer.
PubMed: 28723350
DOI: 10.1016/j.euf.2014.11.001 -
Journal of Minimally Invasive Gynecology Dec 2022This systematic review aimed to review all the available evidence regarding bladder endometriosis (BE) surgical techniques, resolution of symptoms, and nodule size. (Review)
Review
OBJECTIVE
This systematic review aimed to review all the available evidence regarding bladder endometriosis (BE) surgical techniques, resolution of symptoms, and nodule size.
DATA SOURCES
We conducted systematic searches in PubMed MEDLINE, Embase, Latin American and Caribbean Centre on Health Sciences Information, Cochrane Library, and Web of Science databases from inception to December 2021.
METHODS OF STUDY SELECTION
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search yielded 1279 articles. Two reviewers independently screened abstracts and reviewed full-text articles to meet the eligibility criteria: women diagnosed as having BE, treated surgically to remove the BE nodule, and reported of the nodule size and/or symptoms after the surgery. We included 28 studies, which mainly were case reports and case series.
TABULATION, INTEGRATION, AND RESULTS
The following information was extracted from the included studies: author, country, publication year, study design, number of patients, age, surgery performed, follow-up time, operation time, nodule location, nodule size, and postsurgical symptoms. Patients' ages range from 26 to 44 years and most women were nulliparous. The BE nodule size ranged from 0.7 to 5.5 cm, and the most frequent location (63.57%) was the posterior wall. Dysuria was reported by 27.18% of women and generic lower urinary tract symptoms were reported by 27.95%. After surgery, the recurrence rate of urinary symptoms was 7.34%. Most studies performed a partial cystectomy to remove the nodule, showing that the disease affects the bladder mucosa frequently.
CONCLUSION
Surgical treatment with complete excision of BE lesion was shown to improve complaints of urinary symptoms in patients with BE. Given that most of the studies evaluated were descriptive, additional studies with a large sample population and a better level of evidence for this condition are needed.
Topics: Humans; Female; Adult; Urinary Bladder; Laparoscopy; Endometriosis; Urinary Bladder Diseases; Cystectomy
PubMed: 36252916
DOI: 10.1016/j.jmig.2022.10.003 -
Climacteric : the Journal of the... Dec 2016To evaluate the impact of radical cystectomy and urinary diversion on female sexual function. (Review)
Review
OBJECTIVES
To evaluate the impact of radical cystectomy and urinary diversion on female sexual function.
MATERIALS AND METHODS
A Medline search was conducted according to the PRISMA statement for all English full-text articles published between 1980 and 2016 and assessing female sexual function post radical cystectomy and urinary diversion. Eligible studies were subjected to critical analysis and revision. The primary outcomes were the reporting methods for female sexual dysfunction (FSD), manifestations of FSD, and factors associated with FSD, postoperative recoverability of FSD, and awareness level regarding FSD.
RESULTS
From the resulting 117 articles, 11 studies were finally included in our systematic review, with a total of 361 women. Loss of sexual desire and orgasm disorders were the most frequently reported (49% and 39%). Dyspareunia and vaginal lubrication disorders were reported in 25% and 9.5%, respectively. The incidence of sexual dysfunction was 10% in 30 patients receiving genital- or nerve-sparing cystectomy vs. 59% receiving conventional cystectomy.
CONCLUSION
Although female sexual function is an important predictor of health-related quality of life post radical cystectomy and urinary diversion, the available literature is not enough to provide proper information for surgeons and patients.
Topics: Adult; Aged; Cystectomy; Dyspareunia; Female; Humans; MEDLINE; Middle Aged; Postoperative Complications; Quality of Life; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Urinary Diversion
PubMed: 27649461
DOI: 10.1080/13697137.2016.1225714 -
European Urology Mar 2015Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are... (Review)
Review
CONTEXT
Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed.
OBJECTIVE
To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC.
EVIDENCE ACQUISITION
Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted.
EVIDENCE SYNTHESIS
The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-25% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC. Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-29% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 67-76%, 68-83%, and 61-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo.
CONCLUSIONS
Oncologic and functional data from RARC remain immature, and longer-term prospective studies are needed. Cumulative analyses demonstrated that lymph node yields and PSM rates were similar between RARC and ORC. Conclusive long-term survival outcomes for RARC were limited, although oncologic outcomes up to 5 yr were similar to those reported for ORC.
PATIENT SUMMARY
Although open radical cystectomy (RC) is still regarded as the standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RCs are becoming more popular. Templates of lymph node dissection, lymph node yields, and positive surgical margin rates are acceptable with robot-assisted RC. Although definitive comparisons with open RC with respect to oncologic or functional outcomes are lacking, early results appear comparable.
Topics: Chemotherapy, Adjuvant; Chi-Square Distribution; Cystectomy; Disease Progression; Disease-Free Survival; Humans; Lymph Node Excision; Lymphatic Metastasis; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm, Residual; Odds Ratio; Postoperative Complications; Risk Factors; Robotic Surgical Procedures; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 25560797
DOI: 10.1016/j.eururo.2014.12.008 -
The Canadian Journal of Urology Oct 2014Few studies have adequately addressed the indications, efficacy, and quality-of-life for cystectomy performed for non-malignant bladder conditions. Patients with... (Review)
Review
INTRODUCTION
Few studies have adequately addressed the indications, efficacy, and quality-of-life for cystectomy performed for non-malignant bladder conditions. Patients with debilitating non-malignant bladder conditions who have failed all previous conservative therapies may undergo various forms of cystectomy, including partial, simple or radical cystectomy. We provide a review of the current literature and recommendations for cystectomy for various non-malignant bladder conditions.
MATERIALS AND METHODS
A systematic review of MEDLINE was conducted to find prospective and retrospective studies using the keywords "cystectomy", "benign", and `non-malignant`. Articles were reviewed and triaged, background articles were added as supplements, leaving a final review of 67 papers.
RESULTS
Data from the final review suggests that common benign indications for cystectomy are interstitial cystitis/painful bladder syndrome (IC/PBS), neurogenic bladder, hemorrhagic/radiation cystitis, infectious diseases of the bladder and miscellaneous conditions of the bladder such as endometriosis and total refractory incontinence. The most common perioperative complications include urinary tract and wound infections. Efficacy of cystectomy in patients with IC/PBS is greater than 80%, while efficacy in patients with neurogenic bladder is greater than 90%. Finally, improved urinary quality-of-life has been demonstrated in patients with neurogenic bladder post-cystectomy.
CONCLUSION
Cystectomy for non-malignant conditions can be considered for patients who have failed previous conservative therapy. The limited data in existence suggests fertility can be adequately preserved after cystectomy in younger males. The data regarding the forms of urinary diversion suggests no significant advantage between any of the major forms of urinary diversion. Finally, while newer pharmacologics and technological advances are widely used in the treatment of various benign urological conditions, their role in preventing or treating refractory benign bladder conditions have not been fully characterized.
Topics: Cystectomy; Cystitis; Cystitis, Interstitial; Endometriosis; Female; Fertility Preservation; Hematuria; Humans; Male; Patient Selection; Quality of Life; Radiation Injuries; Surgical Wound Infection; Urinary Bladder; Urinary Bladder, Neurogenic; Urinary Diversion; Urinary Tract Infections
PubMed: 25347367
DOI: No ID Found