Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

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Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

Journal of International Medical Research ◽

10.1177/0300060519864806 ◽

2019 ◽

Vol 47 (10) ◽

pp. 4604-4618 ◽

Cited By ~ 2

Author(s):

Hongbin Shi ◽

Jiangsong Li ◽

Kui Li ◽

Xiaobo Yang ◽

Zaisheng Zhu ◽

...

Keyword(s):

Systematic Review ◽

Bladder Cancer ◽

Minimally Invasive ◽

Radical Cystectomy ◽

Meta Analysis ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Lymph Node Yield ◽

Multicenter Rct ◽

Open Radical Cystectomy

Background We performed a systematic review and meta-analysis to evaluate the efficacy and safety of minimally invasive radical cystectomy (MIRC) versus open radical cystectomy (ORC) for bladder cancer. Methods We searched the EMBASE and MEDLINE databases to identify randomized controlled trials (RCTs) of MIRC versus ORC in the treatment of bladder cancer. Results Eight articles describing nine RCTs (803 patients) were analyzed. No significant differences were found between MIRC and ORC in two oncologic outcomes: the recurrence rate and mortality. Additionally, no significant differences were found in three pathologic outcomes: lymph node yield, positive lymph nodes, and positive surgical margins. With respect to perioperative outcomes, however, MIRC showed a significantly longer operating time, less estimated blood loss, lower blood transfusion rate, shorter time to regular diet, and shorter length of hospital stay than ORC. The incidence of complications was similar between the two techniques. We found no statistically significant differences in the above outcomes between robot-assisted radical cystectomy and ORC or between laparoscopic radical cystectomy and ORC with the exception of the complication rate. Conclusions MIRC is an effective and safe surgical approach in the treatment of bladder cancer. However, a large-scale multicenter RCT is needed to confirm these findings.

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Laparoscopic versus Open Radical Cystectomy in Bladder Cancer: A Systematic Review and Meta-Analysis of Comparative Studies

PLoS ONE ◽

10.1371/journal.pone.0095667 ◽

2014 ◽

Vol 9 (5) ◽

pp. e95667 ◽

Cited By ~ 40

Author(s):

Kun Tang ◽

Heng Li ◽

Ding Xia ◽

Zhiquan Hu ◽

Qianyuan Zhuang ◽

...

Keyword(s):

Systematic Review ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Comparative Studies ◽

Meta Analysis ◽

Open Radical Cystectomy

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Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine14973 ◽

2016 ◽

Vol 24 (3) ◽

pp. 416-427 ◽

Cited By ~ 87

Author(s):

Christina L. Goldstein ◽

Kevin Macwan ◽

Kala Sundararajan ◽

Y. Raja Rampersaud

Keyword(s):

Systematic Review ◽

Adverse Event ◽

Adverse Events ◽

Minimally Invasive ◽

Comparative Effectiveness ◽

Meta Analysis ◽

Perioperative Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Patient Reported

OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23–0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was observed. Mean Oswestry Disability Index scores were slightly better in the patients undergoing MIS (n = 346) versus open TLIF/PLIF (n = 346) at a median follow-up time of 24 months (mean difference [MIS – open] = 3.32, p = 0.001). CONCLUSIONS The result of this quantitative systematic review of clinical comparative effectiveness research examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias.

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Robotic or Open Radical Cystectomy, Which Is Safer? A Systematic Review and Meta-Analysis of Comparative Studies

Journal of Endourology ◽

10.1089/end.2014.0033 ◽

2014 ◽

Vol 28 (10) ◽

pp. 1215-1223 ◽

Cited By ~ 20

Author(s):

Hiro Ishii ◽

Bhavan Prasad Rai ◽

Jens-Uwe Stolzenburg ◽

Pradeep Bose ◽

Piotr L. Chlosta ◽

...

Keyword(s):

Systematic Review ◽

Radical Cystectomy ◽

Comparative Studies ◽

Meta Analysis ◽

Open Radical Cystectomy

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Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients

The Journal of Vascular Access ◽

10.1177/11297298211006994 ◽

2021 ◽

pp. 112972982110069

Author(s):

Jonathan De Siqueira ◽

Alexander Jones ◽

Mohammed Waduud ◽

Max Troxler ◽

Deborah Stocken ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

English Language ◽

Controlled Trial ◽

Meta Analysis ◽

Education Programme ◽

Outcome Data ◽

Arteriovenous Fistulae ◽

Structured Education ◽

Significant Difference

Background: Patients who commence haemodialysis (HD) through arteriovenous fistulae and grafts (AVF/G) have improved survival compared to those who do so by venous lines. Objectives: This systematic review aims to assimilate the evidence for any strategy which increases the proportion of HD patients starting dialysis through AVF/G. Data sources: Medline, Embase, Cochrane Central and Scopus. Study eligibility, participants and interventions: English language studies comparing any educational, clinical or service organisation intervention for adult patients with end stage renal failure and reporting incident AVF/G use. Study appraisal and synthesis: Two reviewers assessed studies for eligibility independently. Outcome data was extracted and reported as relative risk. Reporting was performed with reference to the PRISMA statement. Results: Of 1272 studies, 6 were eligible for inclusion. Studies varied in design and intervention. Formal meta-analysis was not appropriate. One randomised controlled trial and two cohort studies assessed the role of a renal access coordinator. Two cohort studies assessed the implementation of qualitive initiative programmes and one cohort study assessed a national, structured education programme. Results between studies were contradictory with some reporting improvements in incident AVF/G use and some no significant difference. Quality was generally low. Conclusions: It is not possible to reach firm conclusions nor make strategic recommendations. A comprehensive package of care which educates and identifies patients approaching dialysis in a timely manner may improve incident AVF/G use. An unbiased, robust comparison of different strategies for timing AVF/G referral is required.

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Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis

The Journal of Urology ◽

10.1016/j.juro.2018.10.006 ◽

2019 ◽

Vol 201 (4) ◽

pp. 715-720 ◽

Cited By ~ 33

Author(s):

Niranjan J. Sathianathen ◽

Arveen Kalapara ◽

Mark Frydenberg ◽

Nathan Lawrentschuk ◽

Christopher J. Weight ◽

...

Keyword(s):

Systematic Review ◽

Radical Cystectomy ◽

Meta Analysis ◽

Robotic Assisted ◽

Open Radical Cystectomy

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Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs

Systematic Reviews ◽

10.1186/s13643-017-0547-y ◽

2017 ◽

Vol 6 (1) ◽

Cited By ~ 19

Author(s):

Susanne Vahr Lauridsen ◽

Hanne Tønnesen ◽

Bente Thoft Jensen ◽

Bruno Neuner ◽

Peter Thind ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Radical Cystectomy ◽

Meta Analysis ◽

Health Related Quality ◽

Robot Assisted ◽

Related Quality ◽

Health Related ◽

Open Radical Cystectomy

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Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.076448 ◽

2011 ◽

Vol 198 (1) ◽

pp. 11-16 ◽

Cited By ~ 112

Author(s):

Corrado Barbui ◽

Andrea Cipriani ◽

Vikram Patel ◽

José L. Ayuso-Mateos ◽

Mark van Ommeren

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Outcome Data ◽

Allocation Concealment ◽

Controlled Trials ◽

Minor Depression ◽

Double Blind ◽

Significant Difference ◽

Study Heterogeneity ◽

Randomised Controlled

BackgroundDepression is a common condition that has been frequently treated with psychotropics.AimsTo review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression.MethodA systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias.ResultsSix studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81–1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR = 1.06, 95% CI 0.65–1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses.ConclusionsThere is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.

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