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Translational Andrology and Urology May 2022
PubMed: 35693708
DOI: 10.21037/tau-22-203 -
Frontiers in Oncology 2022This study aimed to evaluate the efficacy and safety of robotic-assisted radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) in the treatment of...
BACKGROUND
This study aimed to evaluate the efficacy and safety of robotic-assisted radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) in the treatment of bladder cancer.
METHODS
Two researchers independently searched PubMed, Embase, Cochrane, and CBM using the index words to identify the qualified studies which included randomized controlled trials (RCTs) and non-randomized controlled trials (prospective and retrospective studies), and the investigators scanned references of these articles to prevent missing articles. Differences in clinical outcomes between the two procedures were analyzed by calculating odds risk (OR) and mean difference (MD) with an associated 95% confidence interval (CI).
RESULTS
Sixteen comparative studies were included in the meta-analysis with 1467 patients in the RARC group and 897 patients in the LRC group. The results indicated that RARC could significantly decrease blood loss ( = 0.01; MD: -82.56, 95% CI: -145.04 to -20.08), and complications 90 days or more after surgery, regardless of whether patients were Grade ≤ II ( = 0.0008; OR: 0.63, 95% CI: 0.48 to 0.82) or Grade ≥ III ( = 0.006; OR: 0.59, 95% CI: 0.40 to 0.86), as well as overall complications (: 0.01; OR = 0.52; 95% CI: 0.32 to 0.85). However, there was no statistical difference between the two groups at total operative time, intraoperative complications, transfusion rate, short-term recovery, hospital stay, complications within 30 days of surgery, and bladder cancer-related mortality.
CONCLUSIONS
The meta-analysis demonstrates that RARC is a safe and effective treatment for bladder cancer, like LRC, and patients with RARC benefit from less blood loss and fewer long-term complications related to surgery, and should be considered a viable alternative to LRC. There still need high-quality, larger sample, multi-centric, long-term follow-up RCTs to confirm our conclusion.
PubMed: 36439450
DOI: 10.3389/fonc.2022.1024739 -
Journal of Clinical Medicine Feb 2021Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0... (Review)
Review
Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy: Systematic Review and Meta-Analysis.
BACKGROUND
Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3-T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3-T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC.
MATERIALS AND METHODS
A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS).
RESULTS
We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75-0.94; = 0.002) and DSS (HR 0.56, 95% CI 0.32-0.99; = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58-1.35; = 0.58).
CONCLUSIONS
The administration of AC in patients with MIBC and pT3-T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.
PubMed: 33567656
DOI: 10.3390/jcm10040651 -
World Journal of Urology Aug 2019The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC).
METHODS
We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs).
RESULTS
Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs.
CONCLUSIONS
Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.
Topics: Cystectomy; Humans; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 30976902
DOI: 10.1007/s00345-019-02708-8 -
AORN Journal Feb 2022
Meta-Analysis
Topics: Cystectomy; Enhanced Recovery After Surgery; Humans; Length of Stay; Meta-Analysis as Topic; Postoperative Complications; Urinary Bladder Neoplasms
PubMed: 35084766
DOI: 10.1002/aorn.13614 -
Arab Journal of Urology Nov 2020: To assess the prevalence of frailty, a status of vulnerability to stressors leading to adverse health events, in bladder cancer patients undergoing radical cystectomy... (Review)
Review
: To assess the prevalence of frailty, a status of vulnerability to stressors leading to adverse health events, in bladder cancer patients undergoing radical cystectomy (RC), and test the impact of frailty measurements on postoperative adverse outcomes. : A systematic review of English-language articles published up to April 2020 was performed. Electronic databases were searched to quantify the frailty prevalence in RC patients and assess the predictive ability of frailty indexes on RC-related outcomes as postoperative complications, early mortality, hospitalization length (LOS), costs, discharge dispositions, readmission rate. : Eleven studies were selected. Patients' frailty was identified by Johns Hopkins indicator (JHI) in two studies, 11-item modified Frailty Index (mFI) in four, 5-item simplified FI (sFI) in three, 15-point mFI in one, Fried Frailty Criteria in one. Considering all the frailty measurements applied, 8% and 31% of patients were frail or pre-frail, respectively. Frail (43%) and pre-frail patients (35%) were more at risk of major complications compared to non-frail (27%) using sFI; with JHI the percentages of frail and non-frail were 53% versus 19%. According to JHI and mFI frailty was related to longer LOS and higher costs. JHI identified that 3% of frail patients experience in-hospital mortality versus 1.5% of non-frail. Finally, using sFI, frail (28%), and pre-frail (19%) were more likely to be discharged non-home compared to non-frail patients (8%) and had a higher risk of 30-day mortality (4% and 2% versus 1%). : Almost half of RC patients were frail or pre-frail, conditions significantly related to an increased risk of postoperative adverse events with higher rates of major complications and early mortality. The most-used frailty index was mFI, while JHI and sFI resulted the most reliable to predict early postoperative RC-related adverse outcomes and should be routinely included in clinical practice after better standardization throughout prospective comparative studies. : ACG: Adjusted Clinical Groups; ACS: American College Surgeons; AUC: area under the curve; BCa: bladder cancer; CCI: Charlson Comorbidity Index; CSHA-FI: Canadian Study of Health and Aging Frailty Index; CCS: Clavien-Dindo Classification Score; ERAS: Enhanced Recovery After Surgery; FFC: Fried Frailty Criteria; (e)(m)(s)FI: (extended) (modified) (simplified) Frailty Index; ICU: intensive care unit; IQR: interquartile range; (p)LOS: (prolonged) length of hospital stay; NSQIP: National Surgical Quality Improvement Program; OR: odds ratio; (O)PN: (open) partial nephrectomy; PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analyses; (O)(RA)RC: (open)(robot-assisted) radical cystectomy; (O)RN: (open) radical nephrectomy; ROC: receiver operating characteristic; RNU: radical nephroureterectomy; (R)RP: (retropubic) radical prostatectomy; RR: relative risk; THCs: total hospital charges; nephrectomy; UD: urinary diversion.
PubMed: 33763244
DOI: 10.1080/2090598X.2020.1841538 -
International Journal of Surgery... Apr 2018The aim of the study was to systematically review the relevant studies to evaluate the prognosis of primary and progressive muscle-invasive bladder cancer (MIBC) after... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
The aim of the study was to systematically review the relevant studies to evaluate the prognosis of primary and progressive muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC) and provide a clue for the timing of RC in patients with progressive MIBC early at the time of high-risk non-muscle-invasive bladder cancer (NMIBC).
MATERIAL AND METHODS
PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for eligible studies. We extracted hazard ratios (HRs) of overall survival (OS) and cancer-specific survival (CSS) and deaths at 5 and 10 years for each study and performed the meta-analysis using Review Manager 5.3.
RESULTS
A total of 11 retrospective studies with 4102 patients were included in the meta-analysis. The pooled analysis suggested a similar CSS (HR: 1.18; 95% CI, 0.74, 1.87; p = 0.50) and OS (HR: 1.15; 95% CI, 0.82, 1.61; p = 0.43) between primary and progressive MIBC patients treated with RC. The results further indicated no significant differences between the two populations in terms of 5-year CSS rate (OR: 1.32; 95% CI, 0.90, 1.95; p = 0.16), 10-year CSS rate (OR: 0.83; 95% CI, 0.37, 1.83; p = 0.64) as well as 5-year OS rate (OR: 1.02; 95% CI, 0.66, 1.56; p = 0.94). Subgroup analysis according to the starting point of follow-up showed similar outcomes.
CONCLUSION
The meta-analysis demonstrates comparable CSS and OS in patients with primary and progressive MIBC following RC. Novel risk stratifications and prospective trials are urgently needed to investigate the prognosis after RC of these two groups of patients, which could finally aid clinician decision making and select patients who would actually benefit from early RC.
Topics: Cystectomy; Humans; Muscles; Neoplasm Invasiveness; Prognosis; Proportional Hazards Models; Survival Rate; Urinary Bladder Neoplasms
PubMed: 29496649
DOI: 10.1016/j.ijsu.2018.02.049 -
Urology Nov 2009To determine whether health and body image are important determinants of quality of life (QoL) for patients undergoing urinary diversion (UD). Patients with advanced... (Review)
Review
Quality of life and body image for bladder cancer patients undergoing radical cystectomy and urinary diversion--a prospective cohort study with a systematic review of literature.
OBJECTIVES
To determine whether health and body image are important determinants of quality of life (QoL) for patients undergoing urinary diversion (UD). Patients with advanced bladder cancer who undergo cystectomy and UD face potential serious morbidity (25%-40%) and a small risk of mortality (0%-4%). The systematic review compares QoL and body image for different types of diversions.
METHODS
One researcher trained in using schedule for evaluation of individual quality of life-direct weighting interviewed 32 consecutive patients undergoing radical cystectomy. The European Organization for Research and Treatment of Cancer QLQ-C30 and the Satisfaction With Life Scale questionnaire were also administered before cystectomy and 9-12 months postcystectomy. All QoL studies reporting on radical cystectomy and UD were reviewed between 1996 and March 2008.
RESULTS
Family, relationships, health, and finance were the most important determinants of QoL, whereas body image was not mentioned by anyone. On using European Organization for Research and Treatment of Cancer QLQ-C30 and Satisfaction With Life Scale, it was found that there was no difference in QoL of patients pre- and postcystectomy. In our review of published data, 40 studies were identified reporting on 3645 patients. Only 2 studies reported a better QoL in favor of neobladders, whereas 2 other studies suggest a better body image perception in patients with neobladder.
CONCLUSIONS
This prospective cohort study suggests that health and body image may not always be important to patients for their QoL. Our systematic review suggests an overall good QoL in most studies irrespective of the type of UD, with no significant differences among the different diversion types.
Topics: Adult; Aged; Aged, 80 and over; Body Image; Cystectomy; Female; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Urinary Bladder Neoplasms; Urinary Diversion
PubMed: 19773042
DOI: 10.1016/j.urology.2009.05.087 -
European Urology Focus Jun 2016Postcystectomy bladder cancer (BCa) patients are at high risk for developing venous thromboembolism (VTE). The literature varies widely in the reporting of VTE in this... (Review)
Review
Reporting Bias Leading to Discordant Venous Thromboembolism Rates in the United States Versus Non-US Countries Following Radical Cystectomy: A Systematic Review and Meta-analysis.
CONTEXT
Postcystectomy bladder cancer (BCa) patients are at high risk for developing venous thromboembolism (VTE). The literature varies widely in the reporting of VTE in this population.
OBJECTIVE
To determine the VTE rate in subjects undergoing radical cystectomy (RC) and highlight specific factors affecting this rate.
EVIDENCE ACQUISITION
This meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number: CRD42015016776. We queried MEDLINE, the Cochrane Library, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Search terms captured BCa, RC, and VTE. Per the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, abstracts were reviewed for inclusion/exclusion criteria by two reviewers, and disagreements were resolved by a third reviewer. A search of the gray literature and references of pertinent articles was also performed. The date of our last search was December 15, 2014. For unreported data, authors were contacted. Data were abstracted in duplicate and pooled using a random effects (RE) model. Subgroup analyses and meta-regression were performed to determine risk factors for VTE.
EVIDENCE SYNTHESIS
We identified 2927 publications, of which 223 met inclusion criteria for this review. A total of 1 115 634 surgeries were performed on patient population (80% men) with a total of 51 908 VTEs. The VTE rate estimated by the RE model was 3.7%. Due to significant heterogeneity, subgroup and meta-regression analyses were undertaken. These revealed a higher rate of VTE in US studies at 4.49% compared with "westernized" non-US studies at 3.43% and "nonwesternized" non-US based studies at 2.50%. Other important modifiers included minimally invasive surgery at 5.54% versus open surgery at 3.55%, and age. The case-fatality rate of pulmonary emboli was 44%.
CONCLUSIONS
VTE is common in patients undergoing RC. Reporting of VTE is heterogeneous and the rate varies according to study-level factors, including surgery type and country of origin. Limitations of this study include the preponderance of observational studies in the final analysis and lack of complete reporting of all variables of interest within each study.
PATIENT SUMMARY
In this review, we determined the venous thromboembolism (VTE) rate in postsurgical bladder cancer patients. VTE events did vary significantly among certain subgroups.
PubMed: 28723534
DOI: 10.1016/j.euf.2015.09.003 -
Clinical Genitourinary Cancer Aug 2017Port-site metastases (PSMs) are a rare occurrence after robotic surgery. For robot-assisted radical cystectomy (RARC), isolated cases have been reported but management... (Review)
Review
BACKGROUND
Port-site metastases (PSMs) are a rare occurrence after robotic surgery. For robot-assisted radical cystectomy (RARC), isolated cases have been reported but management has not been previously described. We present a case of PSM that occurred after RARC and report the results of our systematic review of previously reported PSMs and describe the treatment options. Search Criteria and Methods: We describe a case of a PSM in a 55-year-old man who had undergone intracorporeal RARC. We performed a systematic review of MEDLINE and Embase databases for previously reported PSMs, detailing the stage and grade of the primary tumor, time to presentation of PSM, treatment offered, and outcomes for the identified cases.
RESULTS
We identified 4 cases of PSMs after RARC in published studies and also included our case for analysis. All 5 patients had muscle-invasive bladder cancer at cystectomy (stage ≥ T2) and 3 had local lymph node-positive disease. Our aggressive treatment of chemotherapy, wide surgical excision of PSM, and radiotherapy provided our patient with a 2-year disease-free status.
CONCLUSION
PSMs are a rare event in RARC, with only 4 other cases reported in published studies. The outcomes have not been well reported for these cases. We propose that multimodality treatment consisting of salvage chemotherapy, surgery, and radiotherapy should be considered, although concessions could be needed after consideration of patient factors.
Topics: Chemoradiotherapy; Combined Modality Therapy; Cystectomy; Disease-Free Survival; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Robotic Surgical Procedures; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 28209455
DOI: 10.1016/j.clgc.2016.06.012