Robot-assisted vs. open radical cystectomy: systematic review and meta-analysis of randomized controlled trials

Fontanet, Sofía; Basile, Giuseppe; Baboudjian, Michael; Gallioli, Andrea; Huguet, J.; Territo, Angelo; Parada, R.; Gavrilov, Pavel; Aumatell, Júlia; Sanz, I. Anquela; Bravo‐Balado, Alejandra; Verri, Paolo; Uleri, Alessandro; Gaya, Joan; Palou, Joan; Breda, Alberto

doi:10.1016/j.acuroe.2023.01.003

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Robotic-assisted surgery in RC has lower blood transfusion rate but longer operative times when compared with open surgery, with all other outcomes being comparable. 31,32…”

Section: Discussionmentioning

confidence: 99%

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Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis

Zein

Nasrallah

Heidar

et al. 2023

Therapeutic Advances in Urology

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Introduction: Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial carcinoma (UTUC) can be concurrently diagnosed, necessitating a combined radical cystectomy (RC) with radical nephroureterectomy (RNU). A systematic review was done on the combined procedure exploring outcomes and indications, in addition to a comparative analysis between the combined procedure and cystectomy alone. Methods: For the systematic review, three databases (Embase, PubMed, and Cochrane) were queried, selecting only studies that included intraoperative and perioperative data. For the comparative analysis, using the NSQIP database, CPT codes for RC and RNU were used to identify two cohorts, one with RC and RNU and one with RC alone. A descriptive analysis was performed on all preoperative variables, and propensity score matching (PSM) was performed. Postoperative events were then compared between the two matched cohorts. Results: For the systematic review, 28 relevant articles were included amounting to 947 patients who underwent the combined procedure. The most common indication was synchronous multifocal disease, the most common approach was open surgery, and the most common diversion technique was using an ileal conduit. Almost 28% of patients required blood transfusion and remained in the hospital for an average of 13 days. The most common postoperative complication was prolonged paralytic ileus. For the comparative analysis, 11,759 patients were included of which 97.5% underwent RC only and 2.5% underwent the combined procedure. After PSM, the cohort that had undergone the combined procedure showed an increased risk of renal injury, increased readmission rates, and increased reoperation rates. Whereas the cohort that had undergone RC only showed an increased risk of deep venous thrombosis (DVT), sepsis, or septic shock. Conclusion: A combined RC and RNU is a treatment option for concurrent UCB and UTUC that should be cautiously utilized as it is associated with high morbidity and mortality. Patient selection, discussion of the risks and benefits of the procedure, and explanation of the available treatment options remain the most important pillars in managing patients with this complex disease.

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“…Robotic-assisted surgery in RC has lower blood transfusion rate but longer operative times when compared with open surgery, with all other outcomes being comparable. 31,32…”

Section: Discussionmentioning

confidence: 99%

“…31,32 journals.sagepub.com/home/tau Summary of 30-day postoperative outcomes in the propensity score matching cohort. , confidence interval; DVT, deep venous thrombosis; MACE, major adverse cardiovascular events; OR, odds ratio; PE, pulmonary embolism; RC, radical cystectomy; SSI, surgical site infection; UTI, urinary tract infection.…”

mentioning

confidence: 99%

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis

Zein

Nasrallah

Heidar

et al. 2023

Therapeutic Advances in Urology

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“…Given the diverse surgical approaches included in the studies, there is presently an insufficient quantity of data to adequately compare open and minimally invasive treatments for RCUN. However, in the context of radical cystectomy, minimally invasive procedures appear to exhibit a lower transfusion rate in comparison to open surgery ( 42 , 43 ). Whether this outcome is applicable to RCUN remains subject to verification in subsequent research.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous radical cystectomy and nephroureterectomy in the treatment of panurothelial carcinoma: a systematic review and single-arm meta-analysis

Liu,

Zhang,

Wen

et al. 2023

Front. Oncol.

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BackgroundPanurothelial carcinoma is a rare and aggressive malignancy that requires effective treatment strategies to enhance patient outcomes.MethodsWe conducted a systematic search of English publications in databases including PubMed, Embase, Cochrane Library, and Web of Science up to May 2023. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS) and the Methodological Quality and Synthesis of Case Series and Case Reports tool. Data statistics and analysis were performed using Stata 15.1 software (StataSE, USA).ResultsSix studies involving 339 patients were included in the analysis. Meta-analysis revealed that Simultaneous Radical Cystectomy and Nephroureterectomy had 2-year and 5-year overall survival rates of 68% (95% CI 60%-76%, I2 = 12.4%, P < 0.001) and 44% (95% CI 36%-53%, I2 = 0, P < 0.001), respectively. The 2-year and 5-year progression-free survival rates were 91% (95% CI 86%-95%, I2 = 95%, P < 0.001) and 65% (95% CI 58%-73%, I2 = 91.5%, P < 0.001), respectively. The 2-year and 5-year cancer-specific survival rates were 73% (95% CI 66%-81%, I2 = 16.7%, P < 0.001) and 57% (95% CI 49%-66%, I2 = 0, P < 0.001), respectively. Additionally, the incidence of minor complications was 19% (95% CI 15%-23%, P < 0.01), major complications was 49% (95% CI 34%-63%, P < 0.01), and the intraoperative blood transfusion rate was 53% (95% CI 44%-61%, P < 0.01).ConclusionsSimultaneous radical cystectomy and nephroureterectomy represent feasible approaches for the treatment of Panurothelial carcinoma. Nonetheless, a comprehensive assessment of the surgical risks and benefits is imperative, and larger-scale prospective cohort studies are required to validate therapeutic efficacy. Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42023426401.

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“…To our knowledge, this is the first study that links inflammatory infiltrate in the stroma of MIBC to the LNM status. Improved tumor microenvironment assessment and intervention are critical to the development of effective therapies for bladder cancer [58]. Further mechanistic studies are needed to validate the predictive patterns of deep learning.…”

Section: Discussionmentioning

confidence: 99%

Predicting Lymph Node Metastasis Status from Primary Muscle-Invasive Bladder Cancer Histology Slides Using Deep Learning: A Retrospective Multicenter Study

Zheng

Jian

Wang

et al. 2023

Cancers

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Background: Accurate prediction of lymph node metastasis (LNM) status in patients with muscle-invasive bladder cancer (MIBC) before radical cystectomy can guide the use of neoadjuvant chemotherapy and the extent of pelvic lymph node dissection. We aimed to develop and validate a weakly-supervised deep learning model to predict LNM status from digitized histopathological slides in MIBC. Methods: We trained a multiple instance learning model with an attention mechanism (namely SBLNP) from a cohort of 323 patients in the TCGA cohort. In parallel, we collected corresponding clinical information to construct a logistic regression model. Subsequently, the score predicted by the SBLNP was incorporated into the logistic regression model. In total, 417 WSIs from 139 patients in the RHWU cohort and 230 WSIs from 78 patients in the PHHC cohort were used as independent external validation sets. Results: In the TCGA cohort, the SBLNP achieved an AUROC of 0.811 (95% confidence interval [CI], 0.771–0.855), the clinical classifier achieved an AUROC of 0.697 (95% CI, 0.661–0.728) and the combined classifier yielded an improvement to 0.864 (95% CI, 0.827–0.906). Encouragingly, the SBLNP still maintained high performance in the RHWU cohort and PHHC cohort, with an AUROC of 0.762 (95% CI, 0.725–0.801) and 0.746 (95% CI, 0.687–0.799), respectively. Moreover, the interpretability of SBLNP identified stroma with lymphocytic inflammation as a key feature of predicting LNM presence. Conclusions: Our proposed weakly-supervised deep learning model can predict the LNM status of MIBC patients from routine WSIs, demonstrating decent generalization performance and holding promise for clinical implementation.

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Robot-assisted vs. open radical cystectomy: systematic review and meta-analysis of randomized controlled trials

Cited by 5 publications

References 25 publications

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis

Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis

Simultaneous radical cystectomy and nephroureterectomy in the treatment of panurothelial carcinoma: a systematic review and single-arm meta-analysis

Predicting Lymph Node Metastasis Status from Primary Muscle-Invasive Bladder Cancer Histology Slides Using Deep Learning: A Retrospective Multicenter Study

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