Bayesian network analysis of open, laparoscopic and Robot-assisted Radical cystectomy.

Abstract

Background We performed the conventional meta-analysis and network meta-analysis to evaluate the safety and efficacy of Robot-assisted Radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) versus open radical cystectomy (ORC) for bladder cancer (BCa). Methods A systematic search of PubMed, Cochrane Library and Embase was performed up to until Dec 20, 2019. Outcome indexes include: oncologic outcomes: the recurrence rate, mortality; pathologic outcomes: Lymph node yield (LNY), Positive lymph node (PLN), positive surgical margins (PSM); perioperative outcomes: operating time (OP), estimated blood loss (EBL), blood transfusion rate, the length of hospital stay, and the time to regular diet. And Postoperative 90-day complications. Results 59 articles describing 8 RCTs, 25 Prospective study, 26 Retrospective study (6944 patients) were analyzed. No significant differences were found between RARC, LEC and ORC in two oncologic outcomes: the recurrence rate and mortality. However, for the recurrence rate, patients with LRC has the highest probability, ORC has the second highest probability, and RARC has the lowest probability. For the mortality, patients with ORC has the highest probability, LRC has the second probability, and RARC has the lowest probability. In three pathologic outcomes: direct meta-analysis indicates that ORC is more than RARC or LRC in PSM and RARC is more than ORC in LNY. On the other hand, network meta-analysis indicates that ORC is more than RARC in PSM. No significant differences were found between RARC, LEC and ORC in other pathologic outcomes: LNY and PLN. for LNY, patients with RARC has the highest probability, ORC has the second highest probability, and LRC has the lowest probability by our network meta-analysis. For PLN, patients with ORC has the highest probability, LRC has the second probability, and RARC has the lowest probability by our network meta-analysis. With respect to perioperative outcomes, direct meta-analysis indicates that RARC is shorter time than LRC or ORC in OP. On the other hand, network meta-analysis indicates that patients with ORC have significantly longer OP than LRC or RARC. Direct meta-analysis and network meta-analysis both indicate that ORC is more than RARC or LRC in EBL, ORC is longer than RARC or LRCConclusion The conventional meta-analysis and network meta-analysis suggest that RARC is a safest and most effective surgical approach in the treatment of BCa and LRC rankes second. However, large sample size and more high-quality studies are still needed to further improve and verify.