在接受根治性膀胱切除术（RC）治疗的膀胱癌患者中，关于年住院人数(HV)和/或外科医生人数(SV)对肿瘤结局和护理质量的影响存在争议.
进行系统评价以评估HV和SV对临床结果的影响。主要结果包括住院，30-d,和90天的死亡率。次要结果包括并发症，长期生存,手术切缘阳性率，淋巴结清扫术的表现，住院时间,neobtrading性能，和失血/输血率。
Medline,Embase,并搜索了Cochrane中央控制试验登记册。2000年以后发表的比较研究，包括因膀胱癌而接受RC的患者，均有资格纳入。膀胱部分切除术是排除标准。根据ROBINS-1工具进行偏倚风险（RoB）评估。
筛选1190篇摘要后，纳入了招募549542名患者的39项研究。所有研究均为回顾性观察队列研究（证据水平3）。22项研究仅报道了HV，只有六项关于SV的研究，两个都有12个。更高的HV，在大多数研究中,HV>10与改善主要和次要结局相关.此外,有证据表明,HV>20可改善结局.对于SV,报告的数据有限且相互矛盾。大多数研究具有中等至高的RoB。对结果进行了叙述合成。
承认较低级别的证据，HV可能与住院有关，30天和90天死亡率，以及评估的次要结果。基于这项研究，欧洲泌尿外科协会肌肉浸润性和转移性膀胱癌指南小组建议医院每年进行至少10次,最好>20次的RCs,或将患者转诊至达到该数字的中心.对于SV,有限和冲突的数据可用。现有证据表明HV而非SV是围手术期结局的主要驱动因素。
目前的文献表明，每年每家医院的膀胱摘除手术次数与术后生存率以及所提供的护理质量有关。
In bladder cancer patients treated with radical cystectomy (RC), controversy exists regarding the impact of the annual hospital volume (HV) and/or surgeon volume (SV) on oncological outcomes and quality of care.
A systematic review was performed to evaluate the impact of HV and SV on clinical outcomes. Primary outcomes included in-hospital, 30-d, and 90-d mortality. Secondary outcomes included complications, long-term survival, positive surgical margin rate, lymphadenectomy performance, length of hospital stay, neobladder performance, and blood loss/transfusion rate.
Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched. Comparative studies published after the year of 2000 including patients who underwent RC for bladder cancer were eligible for inclusion. Partial cystectomy was an exclusion criterion. Risk of bias (RoB) assessment was performed according to the ROBINS-1 tool.
After screening of 1190 abstracts, 39 studies recruiting 549 542 patients were included. All studies were retrospective observation cohort studies (level of evidence 3). Twenty-two studies reported on HV only, six studies on SV only, and 12 on both. Higher HV, specifically an HV of >10, was associated with improved primary and secondary outcomes in most studies. In addition, there is some evidence that an HV of >20 improves outcomes. For SV, limited and conflicting data are reported. Most studies had moderate to high RoB. The results were synthesized narratively.
Acknowledging the lower level of evidence, HV is likely associated with in-hospital, 30- and 90-d mortality, as well as the secondary outcomes assessed. Based on this study, the European Association of Urology Muscle-invasive and Metastatic Bladder Cancer
Guideline Panel recommends hospitals to perform at least 10, and preferably >20, RCs annually or refer the patient to a center that reaches this number. For SV, limited and conflicting data are available. The available evidence suggests HV rather than SV to be the main driver of perioperative outcomes.
Current literature suggests that the number of bladder removal operations per hospital per year is associated with postoperative survival as well as the quality of care provided.
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