Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

World Journal of Surgical Oncology

Research

Kun-peng Li¹  Li Wang²  Ping-yu Zhu²  Xiao-bin Chen²  Shan Yin² 

[1] Department of Urology, Affiliated Hospital of Lanzhou University Second Hospital, 730030, Lanzhou, China;Department of Urology, Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China;

关键词: Nephroureterectomy;    Upper urinary tract urothelial carcinoma;    Transperitoneal;    Retroperitoneal;    Meta-analysis;   

DOI  :  10.1186/s12957-023-03046-1

 received in 2023-03-03, accepted in 2023-05-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe debate on whether to choose a transperitoneal (TP) or retroperitoneal (RP) approach for treating upper urinary tract urothelial carcinoma (UTUC) with laparoscopic surgery has been drawing attention. This study aimed to systematically review and meta-analyze the existing evidence regarding oncologic and perioperative outcomes of transperitoneal laparoscopic radical nephroureterectomy (TLNU) and retroperitoneal laparoscopic radical nephroureterectomy (RLNU) in managing UTUC.MethodsA comprehensive literature search was conducted using PubMed, Scopus, Embase, and Google Scholar for identifying randomized controlled trials (RCTs) and observational studies that evaluated the outcomes of TLNU and RLNU for UTUC. Continuous variables were represented by weighted mean difference (WMD) and standard mean difference (SMD), while binary variables were represented by odds ratio (OR), with 95% confidence intervals (CIs). The quality was assessed using the Newcastle–Ottawa scale. A sensitivity analysis was performed to evaluate the robustness of the estimates.ResultSix observational studies were incorporated into this meta-analysis. The overall TLNU was associated with significantly shorter operating time (WMD − 19.85; 95% CI − 38.03 to − 1.68; P = 0.03); longer recovery time of intestinal function (SMD 0.46; 95% CI 0.08 to 0.84; P = 0.02). However, the terms of estimated blood loss (WMD − 5.72; 95% CI − 19.6 to − 8.15; P = 0.42); length of stay (WMD − 0.35; 95% CI − 1.61 to 0.91; P = 0.59), visual analog pain scale (WMD − 0.38; 95% CI − 0.99 to 0.84; P = 0.22); drainage duration (WMD − 0.22; 95% CI − 0.61 to 0.17; P = 0.26); overall complication rates (OR 1.24; 95% CI 0.58 to 2.63; P = 0.58); local recurrence rate (OR 0.6; 95% CI 0.3 to 1.21; P = 0.16); distant metastasis (OR 0.94; 95% CI 0.04 to 20.77; P = 0.97); 1-year overall survival (OS) (OR 0.45; 95% CI 0.1 to 2.01; P = 0.3) showed no difference between TLNU and RLUN.ConclusionTLNU provides similar surgical outcomes and oncologic results compared to RLUN; however, TLNU has a shorter procedure time and prolonged intestinal function recovery time. Due to the heterogeneity among the studies, randomized clinical trials with follow-ups in the long term are required to obtain more definite results.Trial registrationwww.crd.york.ac.uk/prospero/, identifier CRD42023388554.

【 授权许可】

CC BY   
© The Author(s) 2023

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