Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Topics

Temas

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Surgical mamgement for upper tract transitional cell carcinoma: Summary of findings

We performed a comprehensive search for randomised or quasi‐randomised controlled trials that compared the pre‐stated objectives. Only one randomised control trial comparing laparoscopic nephroureterectomy with open nephroureterectomy was identified (Simone 2009).This trial showed that the laparoscopic approach had superior peri‐operative outcomes when compared with the open approach, which were statistically significant for blood loss (104 mL versus 430 mL; P < 0.001) and mean time to discharge (2.3 days versus 3.65 days). The oncological outcome (bladder tumour free survival, metastasis free survival, cancer‐specific survival curves) at a median follow‐up of 44 months, in organ confined disease, were comparable for the two groups.

There were 22 comparative studies comparing various options of radical nephroureterectomy (open, laparoscopic) as shown in Table 4. Whilst they all showed better early surgical outcomes in the laparoscopic group and comparable oncological outcomes, they were however excluded as they were all retrospective studies. Our search revealed 5 retrospective studies comparing various techniques (open, transurethral and laparoscopic) of dealing with distal end of the ureter. We found three comparative studies between nephron sparing surgery and nephroureterectomy and just one study comparing percutaneous management and nephroureterectomy. These comparisons were again retrospective and were therefore excluded from the study.

Figuras y tablas -
Summary of findings for the main comparison. Surgical mamgement for upper tract transitional cell carcinoma: Summary of findings
Ir a la tabla de la revisión
Table 1. Summary of search findings

 

Database

 

Coverage

 

Search date

July 2008

 

First update

December 2009

 

 

Second update

July 2010

 

Total no. refs

MEDLINE

1950 ‐> present

207

19

9

235

Premedline

22.07.08

0

0

0

0

Embase

1980 ‐>present

157

22

9

188

Cochrane Library

No restrictions

184

5

4

193

Web of Science®

1900 ‐> present

411

100

33

544

 AMED

1985 ‐> present

0

0

0

0

Cinahl

1981‐>present

54

24

11

89

BNI

1985 ‐>present

0

0

0

0

LILACS

1982‐> present

2

0

0

2

Biomed Central

1997‐>present

35

0

3

38

BIOSIS

1926 to present

279

33

7

319

SCOPUS

1981‐>present

478

78

25

581

ASCO abstracts

1981 to present

6

0

1

7

 

 Total no. refs

 

 1813

 281

 102

 2178

 After de‐duplication

 

 1179

 242

 84

 1505
Figuras y tablas -
Table 1. Summary of search findings
Ir a la tabla de la revisión
Table 2. Table 1. Retrospecitive non‐randomised studies comparing the pre‐stated objectives for open and laparoscopic resection.

Study

Surgical comparisons

Bariol 2004

Laparoscopic nephroureterectomy versus open nephroureterectomy

Capitanio 2009

Laparoscopic nephroureterectomy versus open nephroureterectomy

Chung 2007

Hand Assisted Laparoscopic nephroureterectomy versus open nephroureterectomy

Chung 2008

Hand Assisted Laparoscopic nephroureterectomy versus hand‐assisted retroperitoneoscopic nephroureterectomy

Dragicevic 2009

Open conservative surgery versus radical nephroureterectomy

Gill 2000

Laparoscopic nephroureterectomy versus open nephroureterectomy

Goel 2002

Laparoscopic nephroureterectomy versus open nephroureterectomy

Greco 2009

Laparoscopic nephroureterectomy versus open nephroureterectomy

Hattori 2006

Combined (LNU + Open bladder cuff excision) versus pure LNU (LNU + endoscopic bladder cuff excision) versus open nephroureterectomy

Hsueh 2004

Hand‐assisted Retroperitoneoscopic  Laparoscopic nephroureterectomy versus open nephroureterectomy

Hsueh 2007

Hand‐assisted  Laparoscopic nephroureterectomy versus open nephroureterectomy

Kawauchi 2003

Hand Assisted retroperitoneoscopic nephroureterectomy versus open nephroureterectomy

Landmann 2002

Hand‐assisted laparoscopic nephroureterectomy versus standard Laparoscopic nephroureterectomy

Li 2001

Hand assisted laparoscopic nephroureterectomy versus open nephroureterectomy

Lucas 2008

Nephron sparing surgery versus nephroureterectomy  

Manabe 2007

Laparoscopic nephroureterectomy versus open nephroureterectomy

Matsui  2002

Retroperitoneoscopic nephroureterectomy versus open nephroureterectomy

Muller 2007

Laparoscopic nephroureterectomy versus open nephroureterectomy

Okegawa 2006

Retroperitoneoscopic nephroureterectomy versus open nephroureterectomy

Okeke 2002

Hand assisted laparoscopic nephroureterectomy versus open nephroureterectomy

Raman 2006

Hand assisted laparoscopic nephroureterectomy versus open nephroureterectomy

Rassweiler 2004

Laparoscopic nephroureterectomy versus open nephroureterectomy

Stifelman 2001

Hand Assisted Laparoscopic nephroureterectomy versus open nephroureterectomy

Taweemonkongsap 2008

Retroperitoneoscopic nephroureterectomy versus open nephroureterectomy

Romero 2007

Extravesical laparoscopic control of the bladder cuff versus extravesical open control of the bladder cuff

Ko 2007

Open excision of a bladder cuff versus transurethral incision of the ureteral orifice (TUIUO)

Salvador‐Bayarri 2002

Open excision of a bladder cuff versus endoscopic resection of ureter

Matin 2005

Extravesical laparoscopic control of the bladder cuff versus cystoscopic secured detachment and ligation method

Lee 1999

Open nephroureterectomy versus percutaneous approach

Giannarini 2007

Nephron sparing surgery versus nephroureterectomy  

Walton 2009

Endoscopic ureteral detachment versus open Bladder cuff excision
Figuras y tablas -
Table 2. Table 1. Retrospecitive non‐randomised studies comparing the pre‐stated objectives for open and laparoscopic resection.
Ir a la tabla de la revisión
Table 3. Studies comparing the various techniques of en‐bloc excision of the lower ureter during nephroureterectomy procedure.

Study

Objectives

Prinicpal findings

 

Romero 2007

 Extravesical laparoscopic control of the bladder cuff

versus

Extravesical open control of the bladder cuff

·         The laparoscopic group was associated with an increase in the overall rate of recurrence and a shorter recurrence‐free survival

(not statistically significant)

·         Rates of local and bladder recurrence and distant metastases were similar

Ko 2007

 

Open excision of a bladder cuff

versus

Transurethral incision of the ureteral orifice (TUIUO)

·         The bladder recurrence rates were similar in the OC group (22.2%; 6/27) and the TUIUO group (26.3%; 5/19)

·         There were no pelvic recurrences in either group

Salvador‐Bayarri 2002

 

Open excision of a bladder cuff

versus

Endoscopic resection of ureter

·         Bladder tumour recurrence  39% versus 34.5%

·         No statistical significance

Matin 2005

Extravesical laparoscopic control of the bladder cuff

versus

Cystoscopic secured detachment and ligation method

·         Bladder tumour recurrence  41.7% versus 13.9% (not statistically significant)

·         Retroperitoneal Metastasis  8.3%  versus 5.6% (not statistically significant)

·         Distant Metastasis 25% versus 8.3% (not statistically significant)

Walton 2009

Endoscopic ureteral detachment

versus

Open Bladder cuff excision

·         Bladder tumour recurrence  54.4 % versus 47.9% (not statistically significant)   

·         Recurrence free survival and disease specific survival similar for both groups

Figuras y tablas -
Table 3. Studies comparing the various techniques of en‐bloc excision of the lower ureter during nephroureterectomy procedure.
Ir a la tabla de la revisión
Table 4. Studies comparing outcomes of nephron sparing surgery and radical nephroureterectomy

Study

Objectives

Findings

Giannarini 2007

Distal ureter resection with bladder cuff excision and ureter re‐implantation

versus

radical nephroureterectomy with bladder cuff excision

  • Cancer specific survival at 5 and 10 years was not statistically significantly different

(log‐rank test, P = 0.896)

  • Overall survival at 5 and 10 years was not statistically significantly different

(log‐rank test, P = 0.693)

Dragicevic 2009

Open conservative surgery versus Radical nephroureterectomy

  • 5 year survival rates 59% versus 55%

  • 5 year survival rates for imperative and elective indications 41% versus 75%

  • Radical nephroureterectomy had statistically significant poor outcomes for the disease on univariate analysis

(HR = 2.2, 95% CI 1.1 to 4.6, P = 0.030)

Lucas 2008

Nephron sparing surgery versus nephroureterectomy

Low grade disease

  • ·5‐year Overall survival 75.4% versus 66.4% P = 0.281

  • ·5‐year Disease Specific survival 86.2% versus 87.4% P = 0.909

High grade disease

  • ·5‐year overall survival 45% versus 71.5% P = 0.077

  • ·5‐year disease‐specific survival 68.6% versus 75% P = 0.528
Figuras y tablas -
Table 4. Studies comparing outcomes of nephron sparing surgery and radical nephroureterectomy
Ir a la tabla de la revisión