Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis

Abstract

Data regarding the association between surgical margin status and the outcome of bladder cancer treated by radical cystectomy (RC) are conflicting. Therefore, the present meta-analysis was performed to assess the associations between the outcomes of bladder cancer, in terms of recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS), and the presence of positive surgical margins versus negative surgical margins following treatment with RC. Research articles published prior to April 2016 were identified from Pubmed, Embase and the Cochrane Library databases. A total of 36 articles were included, with a sample size of 38,384 bladder cancer patients. Of these, 4,354 patients were reported to have positive surgical margins. Significant associations were detected between positive surgical margins following RC and unfavorable RFS [summary relative risk estimate (SRRE), 1.63; 95% confidence interval (CI), 1.46-1.83; P = 0.105], CSS (SRRE, 1.82; 95% CI, 1.63-2.04; P = 0.001) and OS (SRRE, 1.68; 95% CI, 1.58-1.80; P = 0.805), by fixed or random effects models. The findings were consistent independently of age, sample size, publication year, follow-up duration, study type and geographical region. In summary, the present findings demonstrate that the presence of positive surgical margins is associated with poor survival outcomes in bladder cancer following RC, indicating that avoidance of positive surgical margins during surgery is helpful to improve the prognosis of patients with bladder cancer.

The current status of robot-assisted cystectomy

“…Table 3 summarizes the oncological end-points from traditional ORC series from high-volume centers, as well as RARC versus ORC series, including the 4 RCTs and meta-analyses. [ 41 44 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 ] An overall conclusion that can be drawn from the above studies, further supported by the fact that long-term data are now available, is that RARC is equivalent to ORC in terms of oncological efficacy.…”

The Correlation of Clinicopathological Features With the Status of Surgical Margins in Renal Cell Cancer Patients Following Nephron-Sparing Surgery: A Systematic Review and Meta-Analysis

“…PSMs have been recognized as an adverse prognostic sign for disease prognosis or local recurrence, and thus, NSS may theoretically decrease the probability of complete tumor resection (33). In previous research, the unfavorable effect of PSMs has been described for different types of cancers including: prostate (34), rectal (35), and bladder cancer (36). More recently, the clinical importance of PSMs in RCC patients after NSS was investigated.…”

Is the open cystectomy era over? An update on the available evidence

“…The first meta-analysis showed that positive surgical margins have a negative and statistically significant impact in the survival outcome measures. 64 Most of the studies show a trend for better outcomes of RARC, but these are not statistically significant. Furthermore, all systematic reviews and the meta-analysis of RCTs concur that RARC and ORC have equal margin rates.…”

“…Apart from lymph node dissection, it is also critical to extirpate the disease fully, as reflected by the margin status. The first meta‐analysis showed that positive surgical margins have a negative and statistically significant impact in the survival outcome measures …”