Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis
Abstract Introduction Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high‐risk non‐muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ‐sparing cystec...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | BJUI Compass |
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| Online Access: | https://doi.org/10.1002/bco2.189 |
| _version_ | 1797905370214039552 |
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| author | Reece Clay Raghav Shaunak Siddarth Raj Alexander Light Sachin Malde Ramesh Thurairaja Oussama El‐Hage Prokar Dasgupta Muhammed Shamim Khan Rajesh Nair |
| author_facet | Reece Clay Raghav Shaunak Siddarth Raj Alexander Light Sachin Malde Ramesh Thurairaja Oussama El‐Hage Prokar Dasgupta Muhammed Shamim Khan Rajesh Nair |
| author_sort | Reece Clay |
| collection | DOAJ |
| description | Abstract Introduction Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high‐risk non‐muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ‐sparing cystectomy (OSC) techniques are emerging as an alternative to the standard procedure to preserve these functions, without compromising the oncological outcomes. We present a systematic review and meta‐analysis of the published literature. Methods MEDLINE, Embase and Web of Science were systematically searched for eligible studies on 6 April 2021. Primary outcomes studied were both oncological outcomes, specifically overall recurrence, and functional outcomes, specifically sexual function, and daytime and nighttime continence. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. The PROSPERO registration reference number was CRD42018118897. Results From 13 894 identified abstracts, 19 studies (1886 male and 305 female patients) were eligible for inclusion in this review. These studies included patients who underwent either whole prostate, prostate capsule, seminal vesicle, nerve, uterus, ovary, vagina and fallopian tube sparing techniques. Four studies included only female patients. Thirteen studies reported oncological outcomes, and overall recurrence rate was similar between the two groups (five studies; OR 0.73; 95% CI 0.38–1.40, p = 0.34). Thirteen studies reported on male sexual function. In men, OSC had significantly greater odds of retaining potency (five studies; OR 9.05; 95% CI 5.07–16.16, p < 0.00001). Fourteen studies (13 on males and 1 female) reported urinary outcomes. In men, OSC demonstrated greater odds of daytime (seven studies; OR 2.61; 95% CI 1.74 to 3.92, p < 0.00001) and nighttime continence (seven studies; OR 2.62; 95% CI 1.76 to 3.89, p < 0.00001). Conclusion In carefully selected patients, OSC allows the potential to provide better sexual and urinary function without compromising oncological outcomes. There remains, however, a paucity of OSC studies in females. Further studies are required to make recommendations based on robust clinical evidence. |
| first_indexed | 2024-04-10T10:04:09Z |
| format | Article |
| id | doaj.art-0a6a2578903a46b3b6e1d16f2dfdc7bd |
| institution | Directory Open Access Journal |
| issn | 2688-4526 |
| language | English |
| last_indexed | 2024-04-10T10:04:09Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj.art-0a6a2578903a46b3b6e1d16f2dfdc7bd2023-02-16T02:44:43ZengWileyBJUI Compass2688-45262023-03-014213515510.1002/bco2.189Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysisReece Clay0Raghav Shaunak1Siddarth Raj2Alexander Light3Sachin Malde4Ramesh Thurairaja5Oussama El‐Hage6Prokar Dasgupta7Muhammed Shamim Khan8Rajesh Nair9GKT School of Medical Education King's College London London UKGKT School of Medical Education King's College London London UKGKT School of Medical Education King's College London London UKImperial College London London UKThe Urology Centre, Guy's and St. Thomas' NHS Foundation Trust Guy's Hospital London UKThe Urology Centre, Guy's and St. Thomas' NHS Foundation Trust Guy's Hospital London UKThe Urology Centre, Guy's and St. Thomas' NHS Foundation Trust Guy's Hospital London UKThe Urology Centre, Guy's and St. Thomas' NHS Foundation Trust Guy's Hospital London UKThe Urology Centre, Guy's and St. Thomas' NHS Foundation Trust Guy's Hospital London UKThe Urology Centre, Guy's and St. Thomas' NHS Foundation Trust Guy's Hospital London UKAbstract Introduction Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high‐risk non‐muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ‐sparing cystectomy (OSC) techniques are emerging as an alternative to the standard procedure to preserve these functions, without compromising the oncological outcomes. We present a systematic review and meta‐analysis of the published literature. Methods MEDLINE, Embase and Web of Science were systematically searched for eligible studies on 6 April 2021. Primary outcomes studied were both oncological outcomes, specifically overall recurrence, and functional outcomes, specifically sexual function, and daytime and nighttime continence. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. The PROSPERO registration reference number was CRD42018118897. Results From 13 894 identified abstracts, 19 studies (1886 male and 305 female patients) were eligible for inclusion in this review. These studies included patients who underwent either whole prostate, prostate capsule, seminal vesicle, nerve, uterus, ovary, vagina and fallopian tube sparing techniques. Four studies included only female patients. Thirteen studies reported oncological outcomes, and overall recurrence rate was similar between the two groups (five studies; OR 0.73; 95% CI 0.38–1.40, p = 0.34). Thirteen studies reported on male sexual function. In men, OSC had significantly greater odds of retaining potency (five studies; OR 9.05; 95% CI 5.07–16.16, p < 0.00001). Fourteen studies (13 on males and 1 female) reported urinary outcomes. In men, OSC demonstrated greater odds of daytime (seven studies; OR 2.61; 95% CI 1.74 to 3.92, p < 0.00001) and nighttime continence (seven studies; OR 2.62; 95% CI 1.76 to 3.89, p < 0.00001). Conclusion In carefully selected patients, OSC allows the potential to provide better sexual and urinary function without compromising oncological outcomes. There remains, however, a paucity of OSC studies in females. Further studies are required to make recommendations based on robust clinical evidence.https://doi.org/10.1002/bco2.189continencecystectomyfunctionaloncologicalorgan sparingradical |
| spellingShingle | Reece Clay Raghav Shaunak Siddarth Raj Alexander Light Sachin Malde Ramesh Thurairaja Oussama El‐Hage Prokar Dasgupta Muhammed Shamim Khan Rajesh Nair Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis BJUI Compass continence cystectomy functional oncological organ sparing radical |
| title | Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis |
| title_full | Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis |
| title_fullStr | Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis |
| title_full_unstemmed | Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis |
| title_short | Oncological and functional outcomes of organ‐preserving cystectomy versus standard radical cystectomy: A systematic review and meta‐analysis |
| title_sort | oncological and functional outcomes of organ preserving cystectomy versus standard radical cystectomy a systematic review and meta analysis |
| topic | continence cystectomy functional oncological organ sparing radical |
| url | https://doi.org/10.1002/bco2.189 |
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