kidney_bladder

Surgeons · Clinics · Programme at Sheba Medical Center

• RARC and ORC demonstrated equivalent 90-day overall complications (RR 0.95, 95% CI 0.83–1.07; moderate certainty) and major complications (RR 1.03, 95% CI 0.74–1.44; low certainty) with negligible heterogeneity. 90-day; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• The positive surgical margin rates were similar (RR 1.09, 95% CI 0.54–2.21; low-certainty). Assessment: surgical specimen margins on tissue examination; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• Analysis of crude data showed that risk of major complications (OR: 1.09 95% CI: 0.60, 1.98 I2 = 84%), all complications (OR: 1.77 95% CI: 0.63, 4.95 I2 = 0%), short-term mortality (<1 year) (OR: 2.23 95% CI: 0.63, 7.84 I2 = 57%), long-term mortality (>1 year) (OR: 1.81 95% CI: 0.87, 3.80 I2 = 71%), and readmission rates (OR: 1.55 95% CI: 0.51, 4.65 I2 = 0%) did not differ significantly between frail and non-frail patients. 1 year; Bladder cancer predominantly affects older adults, with approximately 70% of cases occurring in individuals aged ≥65 years, placing a substantial proportion of patients at increased risk of frailty and age-related comorbidities. [5]

• Compared to RAPN (Robot-Assisted Partial Nephrectomy), the CA (Cryoablation) group had a shorter hospital stay [MD -1.76 days; 95% CI -3.12 to -0.41; p = 0.01], less blood loss [MD -104.60 ml; 95% CI -152.58 to -56.62; p < 0.0001], and fewer overall complications [OR 0.62; 95% CI 0.45 to 0.86; p = 0.004], but a higher recurrence rate [OR 7.83; 95% CI 4.32 to 14.19; p < 0.00001]. 1.76 days; Comparative efficacy of cryoablation versus robot-assisted partial nephrectomy in the treatment of cT1 renal tumors: a systematic review and meta-analysis. — This study included a total of 10 studies comprising 2,011 patients. [2]
• The overall adverse events rate was 9.8% (16/163). Study follow-up: Mean follow-up time was 64.2 ± 30.2 months (range, 7-127 months).; The patients were treated by LCA or PCA according to individual situation. [3]
• Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. Study follow-up: Mean follow-up time was 64.2 ± 30.2 months (range, 7-127 months).; The patients were treated by LCA or PCA according to individual situation. [3]

• Deferred CN was associated with superior OS in the primary analysis (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.65-0.84; 5-yr life expectancy difference 5.15 mo, 95% CI 3.23-7.08), all secondary analyses, as well as the tyrosine kinase inhibitor-treated (HR 0.61, 95% CI 0.51-0.74), immune checkpoint inhibitor-treated (HR 0.67, 95% CI 0.46-0.97), and intermediate IMDC/MSKCC risk (HR 0.73, 95% CI 0.55-0.97) subgroups. 5-yr; 5.15 mo; In this report, we compared the outcomes of nephrectomy performed before (upfront) or after (deferred) starting systemic therapy for patients with metastatic kidney cancer. [6]
• Systemic progression before planned CN in the deferred CN arm resulted in a per-protocol recommendation against nephrectomy in 14 patients (29%; 95% CI, 18%-43%). Study follow-up: This randomized clinical trial began as a phase 3 trial on July 14, 2010, and continued until March 24, 2016, with a median follow-up of 3.3 years and a clinical cutoff date for this report of May 5, 2017.; In clinical practice, patients with primary metastatic renal cell carcinoma (mRCC) have been offered cytoreductive nephrectomy (CN) followed by targeted therapy, but the optimal sequence of surgery and systemic therapy is unknown. [7]
• At median follow-up of 23.5 mo, median OS was 29.0 mo (95% confidence interval [CI] 20.1-36.2) for the overall cohort (n = 287), and 49.8 mo (95% CI 33.1-not reached) for the intermediate-risk group (n = 144, 50%) versus 16.3 mo (95% CI 13.5-26.3) for the poor-risk group (n = 143, 50%; hazard ratio [HR] 0.50, 95% CI 0.35-0.71; p < 0.001). 23.5 mo; 29.0 mo; 49.8 mo; 16.3 mo; Patients with synchronous metastatic renal cell carcinoma (s-mRCC) increasingly undergo systemic therapy with their primary tumour in situ. [8]

• The estimated 5-year IVRFS (57.8 vs. 51.0%, p=0.010), CSS (80.4 vs. 76.4%, p=0.032), and OS (75.8 vs. 71.4%, p=0.026) rates were significantly different between the two groups in favor of LNU. 5-year; We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU). [9]
• Moreover, in patients with locally advanced disease (pT3/pT4), the LNU group showed better 5-year IVRFS (62.9 vs. 54.1%, p=0.038), CSS (64.3 vs. 56.9%, p=0.022), and OS (60.4 vs. 53.1%, p=0.018) rates than the ONU group. 5-year; We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU). [9]

• Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03 min;95%CI:5.63,20.43;p = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;p < 0.00001), longer warm ischemia time (WIT) (WMD = 3.84 min;95%CI:2.06,5.62;p < 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;p = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;p = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;p = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73 m²;95%CI:1.40,3.77;p < 0.0001). 0.63days; Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. [10]
• LPN exhibited a noteworthy reduction in the length of hospital stay (weighted mean difference [WMD] -2.06 days, 95% confidence interval [CI] -2.62, -1.50; p < 0.00001), blood loss (WMD -34.05mL, 95% CI -55.61, -12.48; p = 0.002), and overall complications (OR 0.38, 95% CI 0.19, 0.79; p = 0.009). 2.06 days; Perioperative, functional, and oncologic outcomes of laparoscopic partial nephrectomy versus open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis. — This study encompassed a total of seven comparative trials, involving 934 patients. [11]
• Patients undergoing LPN had a significant higher rate of conversion to radical (OR=4.33; 95% CI: 2.01-9.33; P<0.001), a longer ischemia time (IT, P<0.001; WMD=3.02 min; 95% CI: 1.67 to 4.36), a longer length of stay (LOS, P<0.001; WMD=0.67 days; 95% CI: 0.35 to 0.99), a lower rate of positive surgical margin (P=0.03; OR=0.71; 95% CI: 0.53 to 0.96), a greater eGFR decline (P<0.001; WMD=2.41 mL/min/1.73 m2; 95% CI: 1.22 to 3.60), a higher rate of CKD upstaging (P<0.001; OR=2.44; 95% CI: 1.54 to 3.87). 0.67 days; Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors: RENAL score ≥7 or maximum tumor size >4 cm. — Ten observational studies including 5193 patients (LPN: 1574; RAPN: 3619) were included. [12]

• In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. Assessment: surgical specimen margins on tissue examination; These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer. [13]
• The results indicated that RARC could significantly decrease blood loss (P = 0.01; MD: -82.56, 95% CI: -145.04 to -20.08), and complications 90 days or more after surgery, regardless of whether patients were Grade ≤ II (P = 0.0008; OR: 0.63, 95% CI: 0.48 to 0.82) or Grade ≥ III (P = 0.006; OR: 0.59, 95% CI: 0.40 to 0.86), as well as overall complications (P: 0.01; OR = 0.52; 95% CI: 0.32 to 0.85). 90 days; The meta-analysis demonstrates that RARC is a safe and effective treatment for bladder cancer, like LRC, and patients with RARC benefit from less blood loss and fewer long-term complications related to surgery, and should be considered a viable alternative to LRC. [14]
• The 5-yr RFS was 60%, 58%, and 71%; 5-yr CSS was 64%, 68%, and 69%; and 5-yr OS was 55%, 65%, and 61% for ORC, RARC, and LRC, respectively. 5-yr; A review of prospectively maintained database of 60 patients with muscle-invasive bladder cancer (MIBC) or high-risk nonmuscle-invasive bladder cancer (HRNMIBC) who were previously randomised in the CORAL trial to receive ORC, RARC, or LRC. [15]

• With a median follow-up of 36.4 months after the operation, Kaplan-Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs. 88.5%; P = 0.898), recurrence-free survival (77.9% vs. 87.7%; P = 0.180), and cancer-specific survival (91.4% vs. 98.3%; P = 0.153). 36.4 months; A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. [16]
• In clinical T2 subgroup, the recurrence rate and recurrence-free survival in the RLRN group was significantly worse than that in the TLRN group (43.2% vs. 76.7%, P = 0.046). Study follow-up: With a median follow-up of 36.4 months after the operation, Kaplan-Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs.; A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. [16]
• Univariate and multivariate COX regression analysis showed that RLRN (HR: 3.35; 95%CI: 1.12-10.03; P = 0.030), male (HR: 4.01; 95%CI: 1.07-14.99; P = 0.039) and tumor size (HR: 1.23; 95%CI: 1.01-1.51; P = 0.042) were independent risk factor for recurrence-free survival. Study follow-up: With a median follow-up of 36.4 months after the operation, Kaplan-Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs.; A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. [16]

• Standard PLND led to significantly higher 5-year recurrence rates (RR=1.44, 95% CI: 1.28-1.62) compared with the extended approach. 5-year; For decades, pelvic lymph node dissection (PLND) has been a critical component of radical cystectomy in patients with bladder cancer. [17]
• At a median follow-up of 6.1 years, recurrence or death had occurred in 130 patients (45%) in the extended-lymphadenectomy group and in 127 (42%) in the standard-lymphadenectomy group, and the estimated 5-year disease-free survival was 56% and 60%, respectively (hazard ratio for recurrence or death, 1.10; 95% confidence interval [CI], 0.86 to 1.40; P = 0.45). 6.1 years; 5-year; Whether extended lymphadenectomy is associated with improved disease-free and overall survival, as compared with standard lymphadenectomy, among patients with localized muscle-invasive bladder cancer undergoing radical cystectomy is unclear. [18]
• Overall survival at 5 years was 59% in the extended-lymphadenectomy group and 63% in the standard-lymphadenectomy group (hazard ratio for death, 1.13; 95% CI, 0.88 to 1.45). 5 years; Whether extended lymphadenectomy is associated with improved disease-free and overall survival, as compared with standard lymphadenectomy, among patients with localized muscle-invasive bladder cancer undergoing radical cystectomy is unclear. [18]

• Technical success rate was 100%. Assessment: completion of the procedure; Between December 2021 and June 2022, patients underwent high-power MWA for liver, lung, and kidney tumors. [19]
• The major and minor adverse event rates were 8.6% (n = 10) and 17% (n = 19), respectively. Study follow-up: Follow-up ranged between 16 and 161 weeks (median, 50 weeks; mean, 65 weeks).; The mean RENAL score for patients with recurrent and/or residual tumor (8.2 ± 2.7) was higher than that for patients without disease recurrence (6.5 ± 3.5, P = .05). [20]
• During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, P = .10), cancer-specific survival (2.2% vs 3.8%, P = .24), and distant metastases (4.3% vs 4.3%, P = .76). 40.6 months; Percutaneous Microwave Ablation versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Propensity-matched Cohort Study of 1955 Patients. — Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. [21]

• Multivariate analysis revealed that MIS was associated with a significant reduction in 90-day mortality (OR: 0.571; 95%CI: 0.34-0.96, P = 0.033) and improved median OS (53.8 months [95%CI: 50.9-56.9] vs 42.35 months [95%CI: 38.6-46.8], P < 0.001) compared to open surgery. 90-day; 53.8 months; 42.35 months; Using the National Cancer Database (NCDB), patients aged ≥80 years who underwent open or MIS (either robotic or laparoscopic) RNU were identified from 2010 to 2019. [22]

• PCA demonstrated superior outcomes compared to MIPN in terms of shorter hospital stays (WMD: – 2.13 days; 95% Confidence Interval [CI]: – 3.29, – 0.97; p = 0.0003), reduced operative times (WMD: – 109.99 min; 95% CI: – 141.40, – 78.59; p < 0.00001), and lower overall complication rates (OR: 0.54; 95% CI: 0.40, 0.74; p = 0.0001). 2.13 days; The objective of this study was to perform a comprehensive pooled analysis aimed at comparing the efficacy and safety of percutaneous ablation (PCA) versus minimally invasive partial nephrectomy (MIPN), including robotic and laparoscopic approaches, in patients diagnosed with cT1 renal tumors. [23]
• MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) -1.84 days, 95% CI -2.35 to -1.33; P <0.00001], blood loss (WMD -52.42 ml, 95% CI -71.43 to -33.41; P <0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17-0.67; P =0.002], major complications (OR 0.59, 95% CI 0.40-0.86; P =0.007) and overall complications (OR 0.43, 95% CI 0.31-0.59; P <0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. 1.84 days; The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). [24]
• After adjustment by the IPTW analysis, the RAPN group had a shorter operative time (143 vs. 282 min; P = 0.033), shorter postoperative length of hospital stay (PLOS) (4.1 vs. 7.9 days; P = 0.004), and less change in the estimated glomerular filtration rate during surgery (-8.4% vs. -32%; P < 0.0001) than the LRN group; however, the perioperative complication rates were similar. 7.9 days; We compared survival and perioperative outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic radical nephrectomy (LRN) for older patients (age 70 years or older) with stage 1 renal cell carcinoma (RCC). [25]

• Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03 min;95%CI:5.63,20.43;p = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;p < 0.00001), longer warm ischemia time (WIT) (WMD = 3.84 min;95%CI:2.06,5.62;p < 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;p = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;p = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;p = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73 m²;95%CI:1.40,3.77;p < 0.0001). 0.63days; Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. [10]
• A lower positive surgical margin rate was also observed with R-RNTT (OR = 0.20, 95% CI 0.07-0.58, P = 0.003). Assessment: surgical specimen margins on tissue examination; For patients with renal cell carcinoma (RCC) complicated by inferior vena cava (IVC) tumor thrombus, radical nephrectomy combined with thrombectomy remains a key surgical option. [26]
• Deferred CN was associated with superior OS in the primary analysis (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.65-0.84; 5-yr life expectancy difference 5.15 mo, 95% CI 3.23-7.08), all secondary analyses, as well as the tyrosine kinase inhibitor-treated (HR 0.61, 95% CI 0.51-0.74), immune checkpoint inhibitor-treated (HR 0.67, 95% CI 0.46-0.97), and intermediate IMDC/MSKCC risk (HR 0.73, 95% CI 0.55-0.97) subgroups. 5-yr; 5.15 mo; In this report, we compared the outcomes of nephrectomy performed before (upfront) or after (deferred) starting systemic therapy for patients with metastatic kidney cancer. [6]

• DU was not associated with a significant difference in positive surgical margin compared with RNU (RR 1.24, 95% CI 0.64-2.43). Assessment: surgical specimen margins on tissue examination; The oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains debated, particularly in patients for whom renal preservation is clinically desirable. [27]
• Intravesical chemotherapy significantly reduced the risk of intravesical recurrence at 12 months (OR = 0.46; 95% CI: 0.33-0.65; P < 0.001;) and at 24 months (OR = 0.41, 95% CI: 0.28-0.61; P < 0.001). 12 months; 24 months; Sub-analyses were performed on randomized controlled trials and studies involving patients with no history of bladder cancer. [28]
• No significant difference in 5-year CSS was observed between SU and RNU (HR 1.04, [95% confidence interval 0.93. 1.15], P = .49). 5-year; Radical nephroureterectomy (RNU) remains the standard of care for patients with upper tract urothelial carcinoma (UTUC). [29]

• Of the 5104 patients, 2639 had PN (2008 MIS vs 631 OS) and 2465 had RN (1816 MIS vs 649 OS) and most were male (PN: 1657 [62.8%]; RN: 399 [63.1%]) and between 55 and 64 years of age (PN: 1034 [51.3%]; RN: 320 [55.7%]). 64 years; A total of 5104 patients aged 18 to 64 years who underwent PN or RN for kidney cancer and were continuously insured for 180 days before and 365 days after surgery were identified. [30]
• Patients with MIS had lower 1-year postdischarge readmission rate (PN: 15.1% vs 21.5%; odds ratio [OR], 0.65; 95% CI, 0.52-0.82; P < .001; RN: 15.6% vs 18.9%; OR, 0.79; 95% CI, 0.63-1.00; P = .05), and fewer hospital outpatient visits (mean [95% CI] for PN: 4.69 [4.48-4.90] vs 5.25 [4.84-5.66]; P = .01; RN: 5.50 [5.21-5.80] vs 6.71 [6.12-7.30]; P < .001) than those with OS. 1-year; A total of 5104 patients aged 18 to 64 years who underwent PN or RN for kidney cancer and were continuously insured for 180 days before and 365 days after surgery were identified. [30]

• Moreover, in patients with locally advanced disease (pT3/pT4), the LNU group showed better 5-year IVRFS (62.9 vs. 54.1%, p=0.038), CSS (64.3 vs. 56.9%, p=0.022), and OS (60.4 vs. 53.1%, p=0.018) rates than the ONU group. 5-year; We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU). [9]

• MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) -1.84 days, 95% CI -2.35 to -1.33; P <0.00001], blood loss (WMD -52.42 ml, 95% CI -71.43 to -33.41; P <0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17-0.67; P =0.002], major complications (OR 0.59, 95% CI 0.40-0.86; P =0.007) and overall complications (OR 0.43, 95% CI 0.31-0.59; P <0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. 1.84 days; The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). [24]
• LPN exhibited a noteworthy reduction in the length of hospital stay (weighted mean difference [WMD] -2.06 days, 95% confidence interval [CI] -2.62, -1.50; p < 0.00001), blood loss (WMD -34.05mL, 95% CI -55.61, -12.48; p = 0.002), and overall complications (OR 0.38, 95% CI 0.19, 0.79; p = 0.009). 2.06 days; Perioperative, functional, and oncologic outcomes of laparoscopic partial nephrectomy versus open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis. — This study encompassed a total of seven comparative trials, involving 934 patients. [11]
• The 30-day complication rate did not differ between groups: RAPN 41/112 (37%) versus OPN 41/89 (46%) (one-sided: P = 0.088). 30-day; Eligible patients aged ≥18 years had a renal tumour suitable for OPN or RAPN, a RENAL score ≥7, and an estimated glomerular filtration rate ≥50 ml/min/1.73 m2. [31]

• RARC and ORC demonstrated equivalent 90-day overall complications (RR 0.95, 95% CI 0.83–1.07; moderate certainty) and major complications (RR 1.03, 95% CI 0.74–1.44; low certainty) with negligible heterogeneity. 90-day; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• The positive surgical margin rates were similar (RR 1.09, 95% CI 0.54–2.21; low-certainty). Assessment: surgical specimen margins on tissue examination; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• Finally, at network metanalysis, ICUD (OR = 0.74, p < 0.001) but not ECUD (OR = 0.92, p < 0.08) yielded a lower rate of high-grade 90-day complications compared to ORC despite longer OT (MD = 89.56, p = 0.0351). 90-day; Methods: A systematic review identified RCTs including patients aged >18 years with non-metastatic bladder cancer treated with RARC (ICUD or ECUD) vs. [32]

• A lower positive surgical margin rate was also observed with R-RNTT (OR = 0.20, 95% CI 0.07-0.58, P = 0.003). Assessment: surgical specimen margins on tissue examination; For patients with renal cell carcinoma (RCC) complicated by inferior vena cava (IVC) tumor thrombus, radical nephrectomy combined with thrombectomy remains a key surgical option. [26]
• Compared to ORN, RRN was associated with shorter length of stay (WMD -3.06 days; p = 0.002), fewer overall complications (OR 0.56; p < 0.001), lower estimated blood loss (WMD -702 ml; p = 0.01), and higher total hospital costs (WMD US$4520; p = 0.004). 3.06 days; OBJECTIVE: To compare the outcomes of robotic surgery to those of laparoscopic and open surgery in patients undergoing RN for renal cell carcinoma (RCC). [33]
• Major complications (Clavien-Dindo grade ≥III) were observed in 4% of patients, with 30-day mortality in three cases. 30-day; Results The median tumor size was 10.7 cm, with 69 patients (66%) having tumors ≥10 cm. [34]

• RC had longer median OS than PC (67.8 vs. 54.1 months) and on Cox regression analysis (HR 0.88, 95% CI, 0.80-0.95, P = 0.002). 54.1 months; While radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC), partial cystectomy (PC) is an effective alternative in select patients. [35]

• Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03 min;95%CI:5.63,20.43;p = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;p < 0.00001), longer warm ischemia time (WIT) (WMD = 3.84 min;95%CI:2.06,5.62;p < 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;p = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;p = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;p = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73 m²;95%CI:1.40,3.77;p < 0.0001). 0.63days; Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. [10]
• However, no significant differences were found between the two groups in terms of warm ischemia time (WIT) (MD: -0.34, P = 0.69), overall complications (RR: 1.25, P = 0.09), major complications (the Clavien-Dindo classification ≥ 3) (RR: 0.97, P = 0.93), and positive surgical margin (PSM) (RR: 1.06, P = 0.87). Assessment: surgical specimen margins on tissue examination; Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis. — The analysis included five studies meeting the inclusion criteria, with a total of 1440 patients (814 undergoing RP-RAPN and 626 undergoing TP-RAPN). [36]
• PCA was found to have advantageous outcomes in comparison to RAPN regarding hospital stay durations, with a Weighted Mean Difference (WMD) of – 2.03 days (95% Confidence Interval [CI]: -3.78 to – 0.27; p = 0.02), operative times (WMD: -106.75 min; 95% CI: – 170.78 to – 42.72; p = 0.001), and overall complication rates (Odds Ratio [OR]: 0.61; 95% CI: 0.42 to 0.89; p = 0.01). 2.03 days; Percutaneous ablation versus robotic‑assisted partial nephrectomy for cT1 renal cell carcinoma: an evidence-based analysis of comparative outcomes. — In this analysis, data from 1534 patients across 13 studies were evaluated. [37]

• Clavien-Dindo grade ≥ 3 complications (up to 90 days) Extended PLND likely increases Clavien-Dindo grade ≥ 3 complications as compared to standard PLND (risk ratio [RR] 1.22, 95% CI 1.06 to 1.41; 2 studies; 993 participants; moderate-certainty evidence). 90 days; We included randomized controlled trials (RCTs) in which participants underwent radical cystectomy for muscle-invasive or therapy-refractory non-muscle-invasive urothelial carcinoma of the bladder with either an extended PLND with an upper extent reaching as far as the inferior mesenteric artery, or a standard PLND up to the bifurcation of the internal and external iliac artery, with otherwise the same anatomical boundaries. [38]
• Time to recurrence Extended PLND may result in little to no difference in time to recurrence as compared to standard PLND (HR 0.96, 95% CI 0.71 to 1.31; 2 studies, 993 participants; low-certainty evidence). Study follow-up: Based on the control event risk of 39.0% at 90-day follow-up, this corresponds to 86 more complications (95% CI 23 more to 160 more) per 1000 participants.; We included randomized controlled trials (RCTs) in which participants underwent radical cystectomy for muscle-invasive or therapy-refractory non-muscle-invasive urothelial carcinoma of the bladder with either an extended PLND with an upper extent reaching as far as the inferior mesenteric artery, or a standard PLND up to the bifurcation of the internal and external iliac artery, with otherwise the same anatomical boundaries. [38]
• Clavien-Dindo grade ≤ 2 complications (up to 90 days) Extended PLND likely results in similar Clavien-Dindo grade ≤ 2 complications as compared to standard PLND (RR 0.85, 95% CI 0.73 to 1.00; 2 studies, 993 participants; moderate-certainty evidence). 90 days; We included randomized controlled trials (RCTs) in which participants underwent radical cystectomy for muscle-invasive or therapy-refractory non-muscle-invasive urothelial carcinoma of the bladder with either an extended PLND with an upper extent reaching as far as the inferior mesenteric artery, or a standard PLND up to the bifurcation of the internal and external iliac artery, with otherwise the same anatomical boundaries. [38]

• RARC and ORC demonstrated equivalent 90-day overall complications (RR 0.95, 95% CI 0.83–1.07; moderate certainty) and major complications (RR 1.03, 95% CI 0.74–1.44; low certainty) with negligible heterogeneity. 90-day; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• The positive surgical margin rates were similar (RR 1.09, 95% CI 0.54–2.21; low-certainty). Assessment: surgical specimen margins on tissue examination; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• Analysis of crude data showed that risk of major complications (OR: 1.09 95% CI: 0.60, 1.98 I2 = 84%), all complications (OR: 1.77 95% CI: 0.63, 4.95 I2 = 0%), short-term mortality (<1 year) (OR: 2.23 95% CI: 0.63, 7.84 I2 = 57%), long-term mortality (>1 year) (OR: 1.81 95% CI: 0.87, 3.80 I2 = 71%), and readmission rates (OR: 1.55 95% CI: 0.51, 4.65 I2 = 0%) did not differ significantly between frail and non-frail patients. 1 year; Bladder cancer predominantly affects older adults, with approximately 70% of cases occurring in individuals aged ≥65 years, placing a substantial proportion of patients at increased risk of frailty and age-related comorbidities. [5]

• Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03 min;95%CI:5.63,20.43;p = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;p < 0.00001), longer warm ischemia time (WIT) (WMD = 3.84 min;95%CI:2.06,5.62;p < 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;p = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;p = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;p = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73 m²;95%CI:1.40,3.77;p < 0.0001). 0.63days; Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. [10]
• A lower positive surgical margin rate was also observed with R-RNTT (OR = 0.20, 95% CI 0.07-0.58, P = 0.003). Assessment: surgical specimen margins on tissue examination; For patients with renal cell carcinoma (RCC) complicated by inferior vena cava (IVC) tumor thrombus, radical nephrectomy combined with thrombectomy remains a key surgical option. [26]
• The 2-year and 5-year survival rates were 77.5 and 53.1%, respectively. 2-year; 5-year; This meta-analysis aims to review the surgical technique and outcomes of RRN-VCTE in patients with RCC and vena cava tumor thrombus. [39]

• DU was not associated with a significant difference in positive surgical margin compared with RNU (RR 1.24, 95% CI 0.64-2.43). Assessment: surgical specimen margins on tissue examination; The oncologic adequacy of distal ureterectomy (DU) versus radical nephroureterectomy (RNU) for nonmetastatic distal ureteral urothelial carcinoma remains debated, particularly in patients for whom renal preservation is clinically desirable. [27]
• No significant difference in 5-year CSS was observed between SU and RNU (HR 1.04, [95% confidence interval 0.93. 1.15], P = .49). 5-year; Radical nephroureterectomy (RNU) remains the standard of care for patients with upper tract urothelial carcinoma (UTUC). [29]
• Regarding treatment-specific predictors, positive surgical margins were associated with an HR of 3.97 (P = 0.0005), and adjuvant chemotherapy was associated with an HR of 1.65 (P = 0.03). Assessment: surgical specimen margins on tissue examination; Numerous studies have investigated predictors of intravesical recurrence following radical nephrectomy (RNU) in patients with upper urinary tract uroepithelial carcinoma (UTUC). [40]

• The treatment efficacy of RFA was not different with PN in terms of cancer recurrence (OR = 1.22, 95% CI, 0.45-3.28), PFS (HR = 1.26, 95% CI, 0.75-2.11), and CSS (HR = 1.27, 95% CI, 0.41-3.95) as well as major complications (OR = 1.31, 95% CI, 0.55-3.14) (P > 0.05 for all). Study follow-up: This meta-analysis aims to compare the treatment efficacy and safety of RFA and PN for patients with cT1 renal cancer with long-term follow-up of at least 5 years.; Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used for patients who are poor surgical candidates. [41]
• RFA was a potential significant risk factor for OS (HR = 1.76, 95% CI, 1.32-2.34, P < 0.001). Study follow-up: This meta-analysis aims to compare the treatment efficacy and safety of RFA and PN for patients with cT1 renal cancer with long-term follow-up of at least 5 years.; Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used for patients who are poor surgical candidates. [41]
• Five-year CSS was 99%, 96%, and 100% for PN, RFA, and cryoablation, respectively. Five-year; With mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 renal tumors and is appropriate for patients with a contraindication for surgery. [42]

• In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. 3-year; The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. [43]

• The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. Assessment: surgical specimen margins on tissue examination; Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. [44]
• The 3-year RFS was 59% and the 3-year MFS was 76%, with a 3-year OS and CSS of 76% and 88%, respectively. 3-year; Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. [44]

• Relative to RAPN, LPN had a prolonged operative time (OT)(weight mean difference[WMD] = 13.03 min;95%CI:5.63,20.43;p = 0006), longer length of stay (LOS) (WMD = 0.63days;95%CI:0.38,0.88;p < 0.00001), longer warm ischemia time (WIT) (WMD = 3.84 min;95%CI:2.06,5.62;p < 0.0001), higher conversion rate to radical nephrectomy (RN) (OR = 3.14;95%CI:1.64,6.01;p = 0.0006), higher intraoperative complications rates (OR = 1.91;95%CI:1.03,3.53;p = 0.04), higher postoperative complications rates (OR = 1.29;95%CI:1.01,1.64;p = 0.04), greater postoperative decline in estimated glomerular filtration rate (eGFR) (WMD = 2.58mL/min/1.73 m²;95%CI:1.40,3.77;p < 0.0001). 0.63days; Patients suffering through moderate-to-high complexity renal tumors (RENAL-NS ≥ 7), RAPN showed that it was more effective than LPN in lowering OT, WIT, LOS, intraoperative and postoperative complications rates, conversion rate to RN. [10]
• PCA was found to have advantageous outcomes in comparison to RAPN regarding hospital stay durations, with a Weighted Mean Difference (WMD) of – 2.03 days (95% Confidence Interval [CI]: -3.78 to – 0.27; p = 0.02), operative times (WMD: -106.75 min; 95% CI: – 170.78 to – 42.72; p = 0.001), and overall complication rates (Odds Ratio [OR]: 0.61; 95% CI: 0.42 to 0.89; p = 0.01). 2.03 days; Percutaneous ablation versus robotic‑assisted partial nephrectomy for cT1 renal cell carcinoma: an evidence-based analysis of comparative outcomes. — In this analysis, data from 1534 patients across 13 studies were evaluated. [37]
• Compared to RAPN (Robot-Assisted Partial Nephrectomy), the CA (Cryoablation) group had a shorter hospital stay [MD -1.76 days; 95% CI -3.12 to -0.41; p = 0.01], less blood loss [MD -104.60 ml; 95% CI -152.58 to -56.62; p < 0.0001], and fewer overall complications [OR 0.62; 95% CI 0.45 to 0.86; p = 0.004], but a higher recurrence rate [OR 7.83; 95% CI 4.32 to 14.19; p < 0.00001]. 1.76 days; Comparative efficacy of cryoablation versus robot-assisted partial nephrectomy in the treatment of cT1 renal tumors: a systematic review and meta-analysis. — This study included a total of 10 studies comprising 2,011 patients. [2]

• RARC and ORC demonstrated equivalent 90-day overall complications (RR 0.95, 95% CI 0.83–1.07; moderate certainty) and major complications (RR 1.03, 95% CI 0.74–1.44; low certainty) with negligible heterogeneity. 90-day; Robot-assisted versus open radical cystectomy with extracorporeal urinary diversion for bladder cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with subgroup analyses by orthotopic neobladder utilisation. — RESULTS: Five randomized trials (541 patients: 271 RARC and 270 ORC) met the inclusion criteria. [4]
• However, we observed no significant differences, with regards to the operative duration (WMD: 3.48, 95% CI: -28.42, 35.38; I² = 98%, p-heterogeneity < 0.00001, p-overall = 0.83), length of hospitalization (WMD: 0.53, 95% CI: -0.15, 1.21; I² = 85%, p-heterogeneity < 0.00001, p-overall = 0.13), 30-day complication rates (OR: 1.22, 95% CI: 0.83, 1.78; I² = 77%, p-heterogeneity = 0.0005, p-overall = 0.30), 90-day complication rates (OR: 0.92, 95% CI: 0.61, 1.39; I² = 61%, p-heterogeneity = 0.04, p-overall = 0.68), or 30-day readmission rates (OR: 0.86, 95% CI: 0.62, 1.20; I² = 35%, p-heterogeneity = 0.20, p-overall = 0.38). 30-day; 90-day; There is scarce information regarding intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) for the treatment of bladder cancer in patients aged 65 and older. [45]
• In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. Assessment: surgical specimen margins on tissue examination; These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer. [13]

• The 2-year and 5-year survival rates were 77.5 and 53.1%, respectively. 2-year; 5-year; This meta-analysis aims to review the surgical technique and outcomes of RRN-VCTE in patients with RCC and vena cava tumor thrombus. [39]
• Compared to ORN, RRN was associated with shorter length of stay (WMD -3.06 days; p = 0.002), fewer overall complications (OR 0.56; p < 0.001), lower estimated blood loss (WMD -702 ml; p = 0.01), and higher total hospital costs (WMD US$4520; p = 0.004). 3.06 days; OBJECTIVE: To compare the outcomes of robotic surgery to those of laparoscopic and open surgery in patients undergoing RN for renal cell carcinoma (RCC). [33]

• The results showed the rate of identification of detrusor muscle in specimens [odds ratio (OR) 1.90; P = 0.03] was higher in ERBT group, and bladder perforation (OR 0.30; P = 0.004), obturator nerve reflex (OR 0.18; P = 0.001), catheter indwelling time (MD -0.64; P = 0.002), length of hospital stay (MD -0.58; P = 0.002), tumor recurrence rate 3 months after surgery (OR 0.42; P = 0.03), tumor recurrence rate 6 months after surgery (OR 0.21; P = 0.007), the recurrence rate of the same site 1 year after surgery (OR 0.23; P < 0.0001) and bleeding rate (OR 0.30; P = 0.0005) were significantly lower in ERBT group than that in cTURBT group. 3 months; 6 months; 1 year; An updated systematic review, meta-analysis, and trial sequential analysis of the efficacy and safety of en bloc transurethral resection vs. conventional transurethral resection for nonmuscle-invasive bladder tumor. — A total of 12 RCTs involving 2097 patients with NMIBC were included and analyzed. [46]
• There was no significant difference in residual tumor (OR 0.62; P = 0.07), Re-TURBT (OR 0.71; P = 0.19), hemoglobin deficit (MD -0.81; P = 0.29), urethral stricture (OR 0.67; P = 0.42), resection time (MD 2.31; P = 0.16), operative time (MD 1.17; P = 0.49), 1 year (OR 0.61; P = 0.13), 2 years (OR 0.94; P = 0.76), 3-year tumor recurrence rate (OR 1.03; P = 0.86) and the risk of progression at 12 month (OR 0.68; P = 0.79) between the two groups. 1 year; 2 years; 3-year; 12 month; An updated systematic review, meta-analysis, and trial sequential analysis of the efficacy and safety of en bloc transurethral resection vs. conventional transurethral resection for nonmuscle-invasive bladder tumor. — A total of 12 RCTs involving 2097 patients with NMIBC were included and analyzed. [46]
• Over median follow-up of 17 mo, disease recurrence was detected in three patients (23%) in the reTUR arm and six patients (40%) in the upfront BCG arm. 17 mo; Patients with macroscopically completely resected high-grade T1 NMIBC, with or without concomitant carcinoma in situ, and with detrusor muscle (DM) present in the initial TUR specimen were considered eligible for inclusion. [47]