背景:为了评估围手术期,肿瘤学,与标准根治性膀胱切除术(SRC)相比,保留生殖器官的根治性膀胱切除术(ROPRC)治疗女性膀胱癌的功能结局。
方法:在2023年11月对几个科学数据库进行了系统搜索。我们对感兴趣的主要结局进行了系统评价和累积荟萃分析,遵守PRISMA和AMSTAR准则。该研究在PROSPERO(CRD42024501522)中注册。
结果:荟萃分析包括10项研究,共有2015名参与者。与SRC相比,ROPRC显示手术时间和术后禁食时间显着减少(MD-45.69,95%CI-78.91〜-12.47,p=0.007,MD-0.69,95%CI-1.25〜-0.13,p=0.02,分别)。功能成果,白天失禁率(OR4.94,95%CI1.53〜15.91,p=0.008)和夜间失禁率(OR5.91,95%CI1.94〜18.01,p=0.002),女性性功能指数(MD5.72,95%CI0.19〜11.26,p=0.04),在ROPRC组显著改善。在估计失血方面,ROPRC和SRC之间没有显着差异,住院时间,术后总并发症,轻微并发症或严重并发症。肿瘤学上,两种手术均显示出具有可比性的结果,在阳性手术切缘方面无显着差异,肿瘤复发率,总生存率,癌症特异性生存率,无复发生存率,或无进展生存期。
结论:在女性膀胱癌患者中,ROPRC是一种可行且有效的替代SRC的方法,提供增强的功能结果和类似的肿瘤安全性。这些发现表明,ROPRC可以改善女性膀胱癌患者的生活质量,而不会影响癌症治疗的疗效。
BACKGROUND: To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer.
METHODS: A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic
review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522).
RESULTS: The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD - 45.69, 95% CI - 78.91 ~ - 12.47, p = 0.007, and MD - 0.69, 95% CI - 1.25 ~ - 0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival.
CONCLUSIONS: ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.