已经发表了一些比较开放(ORC)和机器人辅助根治性膀胱切除术(RARC)的随机对照试验(RCT)。然而,关于这个问题的不确定性仍然存在,由于仍然缺乏关于RARC的证据和建议。在这篇系统综述和荟萃分析中,我们总结了这方面的证据.根据PRISMA标准进行了文献检索,使用PubMed/Medline,WebofScience和Embase,到2024年3月。仅选择随机对照试验(RCTs)。主要终点是调查手术后3个月和6个月的健康相关生活质量(QoL)。次要终点包括病理和围手术期结果,术后并发症和肿瘤预后。此外,我们根据现有证据进行了成本评估。包括八个RCT,涵盖1024名患者(515RARC和509ORC)。两组在3个月和6个月后的QoL相似。在30天(分别为p=0.11和p>0.9)和90天(分别为p=0.28和p=0.57)的总体和主要并发症没有显着差异,以及肿瘤学,病理和围手术期结果,除手术时间外,在RARC中更长(MD92.34分钟,95%CI83.83-100.84,p<0.001)和输血率,RARC较低(OR0.43,95%CI0.30-0.61,p<0.001)。ORC和RARC都是膀胱癌的可行选择,具有可比的并发症发生率和肿瘤结局。RARC提供输血率优势,然而,它有更长的手术时间和更高的成本。两组的QoL结果相似,三个月和六个月后。
Several randomized control trials (RCTs) have been published comparing open (ORC) with robot-assisted radical cystectomy (RARC). However, uncertainty persists regarding this issue, as evidences and recommendations on RARC are still lacking. In this systematic
review and metaanalysis, we summarized evidence in this context. A literature search was conducted according to PRISMA criteria, using PubMed/Medline, Web Of Science and Embase, up to March 2024. Only randomized controlled trials (RCTs) were selected. The primary endpoint was to investigate health-related quality of life (QoL) both at 3 and 6 months after surgery. Secondary endpoints include pathological and perioperative outcomes, postoperative complications and oncological outcomes. Furthermore, we conducted a cost evaluation based on the available evidence. Eight RCTs were included, encompassing 1024 patients (515 RARC versus 509 ORC). QoL appeared similar among the two groups both after 3 and 6 months. No significant differences in overall and major complications at 30 days (p = 0.11 and p > 0.9, respectively) and 90 days (p = 0.28 and p = 0.57, respectively) were observed, as well as in oncological, pathological and perioperative outcomes, excepting from operative time, which was longer in RARC (MD 92.34 min, 95% CI 83.83-100.84, p < 0.001) and transfusion rate, which was lower in RARC (OR 0.43, 95% CI 0.30-0.61, p < 0.001). Both ORC and RARC are viable options for bladder cancer, having comparable complication rates and oncological outcomes. RARC provides transfusion rate advantages, however, it has longer operative time and higher costs. QoL outcomes appear similar between the two groups, both after 3 and 6 months.