Systematic review and meta-analysis of comparative studies reporting early outcomes after robot-assisted radical cystectomy versus open radical cystectomy

Background: Robot-assisted radical cystectomy (RARC) is increasingly being used in the management of bladder cancer. Studies comparing RARC and open radical cystectomy (ORC) have reported conflicting results. We conducted a systematic review and meta-analysis of the literature on the efficacy and advantages of RARC compared with ORC.     

Differences in short-term outcomes between open versus robot-assisted radical cystectomy in frail malnourished patients

IntroductionWe tested whether frail patients may benefit from robot-assisted (RARC) relative to open radical cystectomy (ORC).Materials and methodsFrail patients treated with RC were identified within the National Inpatient Sample database (2008–2015). The effect of RARC vs. ORC was tested in five separate multivariable models predicting: complications, failure to rescue (FTR), in-hospital mortality, length of stay (LOS) and total hospital charges (THCs). As internal validity measure, analyses were repeated among non-frail patients. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics.ResultsOf 11,578 RC patients, 3477 (30.0%) were frail. RARC was performed in 488 (14.0%) frail patients and 1386 (17.1%) non-frail patients. Among frail, RARC was only independently associated with shorter LOS (median 8 vs. 9 days, relative ratio [RR] 0.79, p < 0.001). Conversely, among non-frail, RARC was independently associated with lower complications (57.3 vs. 59.1%, odds ratio [OR] 0.82, p = 0.004) and shorter LOS (median 6 vs. 7 days, RR 0.88, p < 0.001), but also predicted higher THCs (+2850.3 US dollars, p = 0.001).ConclusionsIn frail patients, the use of RARC did not result in better short-term outcomes except for one-day advantage in LOS. Conversely, in non-frail patients, the use of RARC resulted in lower complication rates and shorter LOS at the cost of higher THCs. In consequence, the benefit of RARC appears relatively marginal in frail patients and our data do not suggest a clear and clinically-meaningful benefit of RARC over ORC in frail radical cystectomy population.     

机器人辅助与腹腔镜膀胱癌根治术疗效对比的Meta分析

目的:通过Meta分析比较机器人辅助膀胱癌根治术（robotic assisted radical cystectomy,RARC）与腹腔镜膀胱癌根治术（laparoscopic radical cystectomy,LRC）手术效果的差异。方法:通过计算机检索PubMed/MedLine、Web of Science、Embase、Cochrane、中国知网、万方医学网、维普期刊数据库中所有已发表有关RARC和LRC疗效对比的中英文文献。检索时间截止至2020年05月31日。利用RevMan 5.3软件进行Meta分析。结果:最终纳入13篇文献,共有病例数1 244例,RARC组690例,LRC组554例。结果显示:与LRC相比,RARC在手术时间（P=0.55)、术后进食时间（P=0.43）、淋巴结阳性检出率（P=0.28）、手术切缘阳性率（P=0.33）、术后复发率（P=0.53）、总体生存率（P=0.43）对比上无统计学差异;而在术中出血量（P=0.002）、输血率（P=0.005）、术后住院时间（P=0.004）、术中淋巴结清扫数目（P=0.000 7）、术后并发症发生率（P＜0.000 01）方面均有统计学差异。结论:与普通腹腔镜相比,机器人手术可减少术中出血量,缩短术后住院时间,并减少并发症。RARC和LRC肿瘤控制结果相似。但由于纳入的研究仅有1项为随机对照研究,结论仍需进一步验证。     

Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study

BackgroundTo compare the long-term survival outcomes between laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH).MethodWe matched patients with stage IA2 to IIA cervical cancer with known risk factors for recurrence who underwent ORH and LRH.ResultsCompared with ORH (n = 263), LRH (n = 263) did not have higher risks of recurrence [hazard ratio (HR) = 1.28; 95% confidence interval (CI) 0.62–2.64] or death (HR = 1.46; 95% CI 0.62–3.43). Even in patients with tumors >2 cm in diameter, the risks of recurrence (HR = 0.82; 95% CI 0.31–2.16) or death (HR = 1.01; 95% CI 0.35–2.95) were not higher for LRH than for ORH. The LRH and ORH group had 5-year recurrence-free survival rates of 92.8% and 94.4%, respectively (P = 0.499). LRH resulted in significantly lower estimated blood loss (379.6 versus 541.1 ml, P < 0.001) and shorter postoperative hospital stay (12.5 versus 20.3 days, P < 0.001). Intraoperative complication rates were similar in the two groups (6.8% versus 5.7%, P = 0.711), but postoperative complication rate was lower in the LRH than in the ORH group (9.2% versus 21%, P < 0.001).ConclusionLRH is an oncologically safe alternative to ORH and was associated with fewer postoperative complication and earlier recovery.     

Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

International Journal of Clinical Oncology - This systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and...     

Minimally invasive adrenalectomy results in equivalent perioperative outcomes versus open adrenalectomy for adrenal mass larger than 6 cm: A retrospective propensity score-matched study

IntroductionThe indication for choosing the minimally invasive approach for large adrenal mass remains controversial. This study is to assess perioperative outcomes after minimally invasive adrenalectomy (MIA) versus open adrenalectomy (OA) for adrenal mass ≥ 6 cm.Materials and methodsA cohort of 173 patients underwent adrenalectomy for adrenal mass ≥ 6 cm in our urology center between May 2005 and April 2018 was included. MIA was performed in 96 patients, whereas 77 patients underwent OA. We performed a retrospective propensity score-matched study to compare MIA versus OA.ResultsAfter propensity score-matched, 58 matched pairs of patients identified from each group. There were no significant differences between the groups in postoperative morbidity (p = 0.146), operative time (p = 0.163), intraoperative hypertension (p = 0.248) and drainage time (p = 0.188). Estimated blood loss, the rate of blood transfusions postoperative hospital stay was less in MIA group (p < 0.0001; p = 0.007; p < 0.0001). Total expense was significantly more in the MIA group [49379.28 (38496.69, 68008.69) CNY vs 39951.48 (30666.33, 50292.03) CNY, p = 0.001].ConclusionsMIA results in equivalent perioperative outcomes compared with OA and is an effective and safe surgical method for patients with an adrenal mass more than 6 cm in diameter.     

Minimal-invasive versus open hepatectomy for hepatocellular carcinoma: Comparison of postoperative outcomes and long-term survivals using propensity score matching analysis

Background

Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising results. However, the role of MIH for the treatment of patients with hepatocellular carcinoma (HCC) needs further investigation.

Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: Systematic review and meta-analysis of propensity score-matched studies

ObjectiveTo compare the effects of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) on the short-term and long-term outcomes of patients with intrahepatic cholangiocarcinoma (ICC) through a meta-analysis of studies using propensity score-matched cohorts.MethodsThe literature search was conducted in PubMed, Embase, and Cochrane Library databases until August 31, 2022. Meta-analysis of surgical (major morbidity, the length of hospital stay, 90-day postoperative mortality), oncological (R0 resection rate, lymph node dissection rate) and survival outcomes (1-, 3-, and 5-year overall survival and disease-free survival) was performed using a random effects model. Data were summarized as relative risks (RR), mean difference (MD) and hazard ratio (HR) with 95% confidence intervals (95% CI).ResultsSix case-matched studies with 1054 patients were included (LH 518; OH 536). Major morbidity was significantly lower (RR = 0.57, 95% CI = 0.37–0.88, P = 0.01) and the length of hospital stay was significantly shorter (MD = −2.44, 95% CI = −4.19 to −0.69, P = 0.006) in the LH group than in the OH group, but there was no significant difference in 90-day postoperative mortality between the 2 groups. There were no significant differences in R0 resection rate, lymph node dissection rate, 1-, 3-, and 5-year overall survival or disease-free survival between the LH and OH groups.ConclusionsLH has better surgical outcomes and comparable oncological outcomes and survival outcomes than does OH on ICC. Therefore, laparoscopy is at least not inferior to open surgery for intrahepatic cholangiocarcinoma.     

Comparison of intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy at a medium-sized facility

International Journal of Clinical Oncology - The aim of this study is to compare the perioperative outcomes and learning curves between intracorporeal and extracorporeal urinary diversion at our...     

Patient frailty predicts worse perioperative outcomes and higher cost after radical cystectomy

Background: Relatively few studies investigated the importance of frailty in radical cystectomy (RC) patients. We tested the ability of frailty, using the Johns Hopkins Adjusted Clinical Groups indicator, to predict early perioperative outcomes after RC.Methods: RC patients were identified within the National Inpatient Sample database (2000–2015). The effect of frailty, age and Charlson Comorbidity Index were tested in five separate multivariable models predicting: (1) complications, (2) failure to rescue (FTR), (3) in-hospital mortality, (4) length of stay (LOS) and (5) total hospital charges (THCs). All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics.Results: Of 23,967 RC patients, 5833 (24.3%) were frail, 7721 (32.2%) were aged ≥75 years and 2832 (11.8%) had CCI ≥2. Frailty, age ≥75 years and CCI ≥2 were non-overlapping in 86.3% of the cohort. Any two or three of these features were recorded in 12.4 and 1.3%, respectively. Frailty was an independent predictor of all five examined endpoints and the magnitude of its association was stronger or at least equal than that of age ≥75 years and CCI ≥2.Conclusion: Frailty, advanced age and comorbidities represent non-overlapping patients’ characteristics. Of those, frailty represents the most consistent and strongest predictor of early adverse outcomes after RC. Ideally, all three indicators should be considered in retrospective, as well as prospective analyses. Pre-surgical recognition of frail patients should be ideally incorporate in clinical practice in order to address these patients to multimodal pre-habilitation programs that may potentially improve the perioperative prognosis.     

Impact of spontaneous rupture on the survival outcomes after liver resection for hepatocellular carcinoma: A propensity matched analysis comparing ruptured versus non-ruptured tumors

IntroductionSpontaneous rupture of HCC (srHCC) is a life-threatening sequela of HCC characterized by a high mortality. Liver resection (LR) is the ideal therapeutic strategy as it not only arrests hemorrhage but also remove the offending tumour. We sought to determine the impact of spontaneous rupture on the survival outcomes of patients after LR by performing a propensity score matched (PSM) analysis comparing patients who underwent LR for srHCC versus non-ruptured (nrHCC).MethodsFrom 2000 to 2015, a total of 67 patients who underwent LR for srHCC which met the study criteria were included. 1:2 PSM was performed comparing 49 of 67 patients with srHCC with 98 nrHCC selected from a cohort of 724 patients who underwent LR during the study period.ResultsMedian survival following LR for srHCC was 21.9 months, while 5-year overall survival (OS) and disease-free survival (DFS) was 43.1% and 19.4% respectively. After 1:2 PSM analysis, there was no significant difference between LR for srHCC (n = 49) versus nrHCC (n-98) in terms of OS [21.9 (interquartile range (IQR), 11.8–44.0 vs 27.4 (IQR, 6.9–57.8) months, HR 1.02, CI 0.63–1.66, p = 0.94], DFS [11.8 (IQR, 5.6–25.6) vs 13.77 (IQR,4.5–34.9) HR 0.74, CI 0.54–1.02, p = 0.06] and length of stay [8 (IQR, 7–11) vs 7 (IQR, 6–10) HR 0.93, CI 0.0.68–1.29), p = 0.68].ConclusionLR for clinically stable patients with srHCC provides survival and recurrence outcomes that are comparable to patients with nrHCC.     

Robotic-assisted radical cystectomy: current technique and outcomes

Robotic-assisted radical cystectomy continues to evolve as a surgical option in the management of muscle-invasive bladder cancer. Current oncologic outcomes appear comparable in the short-term with open radical cystectomy. Long-term follow-up, however, remains lacking for this emerging technique. Modern robotic technology allows a comparable extent of pelvic lymph node dissection as open surgery, a previous criticism of the procedure. Complications compare very favorably to open surgery in comparative series, and blood loss and transfusion rates are routinely lower. Length of stay has been shortened in some series, though not uniformly. Finally, robotic assistance can increase the cost of radical cystectomy.     

Robotic-assisted radical cystectomy: current technique and outcomes

Robotic-assisted radical cystectomy continues to evolve as a surgical option in the management of muscle-invasive bladder cancer. Current oncologic outcomes appear comparable in the short-term with open radical cystectomy. Long-term follow-up, however, remains lacking for this emerging technique. Modern robotic technology allows a comparable extent of pelvic lymph node dissection as open surgery, a previous criticism of the procedure. Complications compare very favorably to open surgery in comparative series, and blood loss and transfusion rates are routinely lower. Length of stay has been shortened in some series, though not uniformly. Finally, robotic assistance can increase the cost of radical cystectomy.     

Perioperative and mid-term oncologic outcomes of robotic assisted radical cystectomy with totally intracorporeal neobladder: Results of a propensity score matched comparison with open cohort from a single-centre series

Aim

In this study, we compared perioperative and oncologic outcomes of patients treated with either open or robot-assisted radical cystectomy and intracorporeal neobladder at a tertiary care center.

Radical resection versus local excision for low rectal gastrointestinal stromal tumor: A multicenter propensity score-matched analysis

BackgroundThe surgical approaches and resection extent for rectal gastrointestinal stromal tumors (GISTs) are controversial due to the low incidence of this disease. A multicenter retrospective cohort study was conducted to compare the postoperative and oncologic outcomes of local excision (LE) and radical resection (RR) in patients with low rectal GIST.Patients and methodsThe medical records of rectal GIST patients from 11 large-scale medical centers in China (January 2000-December 2019) were reviewed. All patients were divided into either the LE group or the RR group. Propensity score matching (PSM) was conducted to reduce confounders.ResultsA total of 280 patients with low rectal GIST were enrolled. After PSM, 144 patients were included (72 in each group). The LE group showed a higher anal preservation rate (100.0% vs. 76.4%, P < 0.001), shorter operation time (77.1 ± 68.4 min vs. 159.1 ± 83.6 min, P < 0.001), fewer complications (8.3% vs. 22.2%, P = 0.021) and shorter postoperative hospital stay (4.9 ± 4.1 d vs. 10.7 ± 8.1 d, P < 0.001) than the RR group. There was no significant difference in recurrence-free survival (RFS) between the RR and LE groups among patients with tumors ≤2 cm (P = 0.220), and the RR group had a superior RFS than the LE group in patients with tumors >2 cm (P = 0.046).ConclusionsLE resulted in improved postoperative outcomes and comparable oncological safety with a low rectal GIST of ≤2 cm. However, for patients with a low rectal GIST of >2 cm, RR might be a more appropriate option with better RFS.     

Prophylactic aprepitant is better than salvage for carboplatin-based chemotherapy: a propensity score-matched analysis

Aprepitant prevents chemotherapy-induced nausea and vomiting (CINV) in carboplatin-containing chemotherapy. However, it is unknown whether aprepitant salvage therapy after the development of emesis is as effective as adding prophylactic aprepitant to doublet therapy with dexamethasone and a 5-HT₃ receptor antagonist from the first cycle of chemotherapy. To compare the antiemetic efficacy of aprepitant between salvage and prophylactic administration in the second cycle of carboplatin-containing chemotherapy, twenty-two NSCLC patients who developed CINV in the first cycle of carboplatin-containing therapy without aprepitant (salvage group) and 44 patients who received aprepitant (prophylaxis group) were extracted from the pooled data of two clinical trials, with adjustment for age, sex, and chemotherapeutic regimen as co-variables using propensity score matching. In the second cycle of chemotherapy, both groups received aprepitant, and the rate of antiemetic complete response (no vomiting and no rescue therapy) at 5 days after chemotherapy was compared. The prophylaxis group demonstrated a significantly better overall complete response rate (88.6%; 95% confidence interval [CI] 75.4–96.2) compared with that of observed for the salvage group (68.2%; 95% CI 45.1–86.1, p?=?0.042). The prophylaxis group also demonstrated a significantly lower proportion of any-grade nausea (43.2%) and appetite loss (43.2%) than the salvage group (72.7%, p?=?0.036 and 77.3%, p?=?0.010, respectively). Adding aprepitant to doublet therapy from the first cycle of carboplatin-containing chemotherapy may be more effective than salvage use of aprepitant after the development of CINV.     

Prognostic factors,pattern of recurrence and survival in a Danish bladder cancer cohort treated with radical cystectomy

A cohort of 248 consecutive patients with bladder cancer undergoing radical cystectomy between 1992 and 98 was retrospectively followed from diagnosis until death. Prognostic factors, pattern of recurrence and survival were analysed. Pathological T and N, angiolymphatic and perineural invasion had an independent prognostic influence on survival. Patients without muscle-invasive tumour (Ta, T1) had a good prognosis, whereas patients with primarily superficial tumour progressing to muscle-invasive tumour had a significantly poorer outcome. Forty-six percent of these patients developed recurrences in the follow-up period, with a median time from recurrence to death of 5 months. The 5-year disease-specific survival for all 248 patients was 57%. Patients with pT4b or N + all died within 3 years. Patients with positive lymph nodes or T4b were not curable with cystectomy alone. Patients with advanced T or with perineural/vessel invasion are in need of improved treatment options. Patients with superficial tumours at high risk of progression should be offered early cystectomy.     

Syngeneic hematopoietic stem cell transplantation for acute myeloid leukemia: a propensity score-matched analysis

The present study evaluated outcomes and prognostic factors in adult patients with acute myeloid leukemia (AML) after syngeneic hematopoietic stem cell transplantation (HSCT). Among patients in first complete remission (CR1), outcomes of syngeneic HSCT (Syn) were compared with those of autologous HSCT (Auto), allogeneic HSCT from human leukocyte antigen (HLA)-matched sibling donor (MSD), or allogeneic HSCT from HLA-matched unrelated donor (MUD). Among 11,866 patients receiving first HSCT, 26 in the Syn group were analyzed. The 5-year overall survival (OS) rate, the cumulative incidence of relapse, and the cumulative incidence of non-relapse mortality (NRM) were 47.8%, 59.6%, and 4.6%, respectively. The OS was significantly better in patients in CR1 (n = 13) than in patients in non-CR1 (P = 0.012). Furthermore, 39 patients in CR1 each were assigned to the Auto, MSD, and MUD groups using propensity score matching. The 5-year OS in the Syn (68.4%) was not significantly different from those in the Auto (55.9%, P = 0.265), MSD (62.4%, P = 0.419), or MUD (63.7%, P = 0.409) groups. A higher relapse in the Syn than in the MSD and MUD groups was offset by lower NRM. In summary, syngeneic HSCT might be an alternative option for AML patients in CR1.Subject terms: Acute myeloid leukaemia, Cancer immunotherapy