المؤلفون: Chen, Changhao, Lin, Tianxin, Zhou, Yu, Li, Doudou, Xu, Kewei, Li, Zhihua, Fan, Xinxiang, Zhong, Guangzheng, He, Wang, Chen, Xu, He, Xianyin, Huang, Jian

المصدر: PLoS ONE; Aug2014, Vol. 9 Issue 8, p1-14, 14p

مصطلحات موضوعية: RADIOTHERAPY, PROSTATECTOMY, SYSTEMATIC reviews, META-analysis, SURGICAL excision, ADJUVANT treatment of cancer

مستخلص: Purpose: In men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). Materials and Methods: We comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT. Results: Between May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30–0.46; p<0.00001, I² = 0%). 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28–0.52; p<0.00001, I² = 0%). Overall survival (OS) was also better in the ART (RR: 0.53; 95% CI, 0.41–0.68; p<0.00001, I² = 0%), as did disease free survival (DFS) (RR: 0.53; 95% CI, 0.43–0.66; p<0.00001, I² = 0%). Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis. Conclusion: ART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis. [ABSTRACT FROM AUTHOR]

: Copyright of PLoS ONE is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Bi, Liangkuan, Huang, Hai, Fan, Xinxiang, Li, Kaiwen, Xu, Kewei, Jiang, Chun, Liu, Hao, Dong, Wen, Zhang, Simin, Yang, Xiangyun, Lin, Tianxin, Huang, Jian

المصدر: BJU International; May2014, Vol. 113 Issue 5b, pE39-E48, 10p

مصطلحات موضوعية: LYMPH nodes, BLADDER cancer, CYSTECTOMY, META-analysis, CLINICAL trials

مستخلص: Objective To compare extended pelvic lymph node dissection ( ePLND) with non-extended pelvic lymph node dissection (non- ePLND) and assess their influence on recurrence-free survival ( RFS) in patients undergoing radical cystectomy for bladder cancer., Methods Through a comprehensive search of the PubMed, Embase and Cochrane Library databases in September 2012, we performed a systematic review and cumulative meta-analysis of all comparative studies assessing the extent of pelvic lymph node dissection ( PLND) and its influence on RFS., Results Six studies with a total of 2824 patients were identified., Overall analysis showed a significantly better RFS rate in patients who had undergone ePLND than in those who had undergone non- ePLND (hazard ratio [ HR]: 0.65; P < 0.001)., A subgroup analysis found that, compared with non- ePLND, ePLND was associated with a better RFS rate for both patients with negative lymph nodes ( HR: 0.68; P = 0.007) and those with positive lymph nodes ( HR: 0.58; P < 0.001). When stratified by pathological T stage, ePLND provided additional RFS benefits for patients with pT3-4 disease ( HR: 0.61; P < 0.001), but not for patients with ≤ pT2 disease ( HR: 0.95; P = 0.81)., Conclusions The results of this meta-analysis indicate that ePLND provides a RFS benefit compared with non- ePLND. On subgroup analysis, ePLND provides better RFS not only for patients who had positive lymph nodes and pT3-4 disease, but also for patients with negative lymph nodes., Two randomized controlled trials on ePLND vs non- ePLND are awaited which should provide more clinically meaningful results. [ABSTRACT FROM AUTHOR]

: Copyright of BJU International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Li, Kaiwen, Lin, Tianxin, Zhang, Caixia, Fan, Xinxiang, Xu, Kewei, Bi, Liangkuan, Han, Jinli, Huang, Hai, Liu, Hao, Dong, Wen, Duan, Yu, Yu, Min, Huang, Jian

المصدر: Journal of Urology; Oct2013, Vol. 190 Issue 4, p1260-1267, 8p

مصطلحات موضوعية: URINARY calculi, EXTRACORPOREAL shock wave lithotripsy, TREATMENT duration, RANDOMIZED controlled trials, SYSTEMATIC reviews, META-analysis, THERAPEUTICS

مستخلص: Purpose: The optimal frequency of shock wave lithotripsy in urolithiasis has not been well determined. Materials and Methods: A search of MEDLINE®, Web of Science and the Cochrane Library was performed. All randomized controlled trials including articles and meeting abstracts that compared the effects of different frequencies (120, 90 and 60 shock waves per minute) of shock wave lithotripsy were included in analysis. The review process followed the guidelines of the Cochrane Collaboration. Results: Nine randomized controlled trials including 1,572 cases were identified. Overall success rates and success rates for large stones (greater than 10 mm) were significantly lower in the 120 vs 60 (p <0.001 and p = 0.002, respectively) and in the 120 vs 90 (p <0.001 and p = 0.02, respectively) shock waves per minute groups, but similar between the 90 and 60 shock waves per minute groups. Treatment duration was significantly shorter in the 120 vs 60, 120 vs 90 and 90 vs 60 shock waves per minute groups (all p <0.001). Success rates for small stones (less than 10 mm), complication rates and total shock waves had no significant differences among the 3 groups. Conclusions: Decreasing the frequency from 120 to 60 shock waves per minute increased overall success rates. While the treatment duration of 60 shock waves per minute was much greater, 90 shock waves per minute seemed to be optimal, especially for large stones. A frequency of 120 shock waves per minute might still be recommended for small stones. [Copyright &y& Elsevier]

: Copyright of Journal of Urology is the property of Wolters Kluwer UK and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Li, Kaiwen, Lin, Tianxin, Fan, Xinxiang, Xu, Kewei, Bi, Liangkuan, Duan, Yu, Zhou, Yu, Yu, Min, Li, Jielin, Huang, Jian

المصدر: Cancer Treatment Reviews; Oct2013, Vol. 39 Issue 6, p551-560, 10p

مستخلص: Abstract: Background: Robot-assisted radical cystectomy (RARC) is increasingly being used in the management of bladder cancer. Studies comparing RARC and open radical cystectomy (ORC) have reported conflicting results. We conducted a systematic review and meta-analysis of the literature on the efficacy and advantages of RARC compared with ORC. Methods: An electronic database search of PubMed, Scopus, and the Cochrane Library was performed up to July 8, 2012. This systematic review and meta-analysis was performed based on all randomized controlled trials (RCTs) and observational comparative studies assessing the two techniques. Results: One RCT, eight studies with prospectively collected data, and four retrospective studies were identified, including 962 cases. Although RARC was associated with longer operative time (p <0.001), patients in this group might benefit from less overall perioperative complications (p =0.04), more lymph node yield (p =0.009), less estimated blood loss (p <0.001), a lower need for perioperative transfusion (p <0.001), and shorter length of hospital stay (p< 0.001). Positive surgical margins did not differ significantly between techniques. Sensitivity analysis with prospective studies showed similar results to the original analysis, but no significant difference of lymph node yield and length of stay between two techniques. Conclusions: RARC is a mini-invasive alternative to ORC with less overall perioperative complications, more lymph node yields, less estimated blood loss, less need for a perioperative transfusion, and shorter length of stay. [Copyright &y& Elsevier]

: Copyright of Cancer Treatment Reviews is the property of W B Saunders and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Bi, Liangkuan, Zhang, Caixia, Li, Kaiwen, Fan, Xinxiang, Xu, Kewei, Han, Jinli, Huang, Hai, Liu, Hao, Dong, Wen, Yang, Xiangyun, Huang, Jian, Lin, Tianxin

المصدر: PLoS ONE; Oct2013, Vol. 8 Issue 10, p1-6, 6p

مصطلحات موضوعية: ROBOTICS, NEPHRECTOMY, KIDNEY tumors, SYSTEMATIC reviews, UROLOGY, SURGICAL complications, META-analysis

مستخلص: Background: With the establishment of minimally invasive surgery in society, the robot has been increasingly widely used in the urologic field, including in partial nephrectomy. This study aimed to comprehensively summarize the currently available evidence on the feasibility and safety of robotic partial nephrectomy for renal tumors of >4 cm. Method and Findings: An electronic database search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed. This systematic review and meta-analysis was based on all relevant studies that assessed robotic partial nephrectomy for renal tumors of >4 cm. Five studies were included. The meta-analysis involved 3 studies from 11 institutions including 154 patients, while the narrative review involved the remaining 2 studies from 5 institutions including 64 patients. In the meta-analysis, the mean ischemic time, operation time, and console time was 28, 319, and 189 minutes, respectively. The estimated blood loss and length of stay was 317 ml and 3.8 days, respectively. The rates of conversion, positive margins, intraoperative complications, postoperative complications, hilar clamping, and collecting system repair were 7.0%, 3.5%, 7.0%, 9.8%, 93.9%, and 47.5%, respectively. The narrative review showed results similar to those of the meta-analysis. Conclusions: Robotic partial nephrectomy is feasible and safe for renal tumors of >4 cm with an acceptable warm ischemic time, positive margin rate, conversion rate, complication rate, operation time, estimated blood loss, and length of stay. [ABSTRACT FROM AUTHOR]

: Copyright of PLoS ONE is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Fan, Xinxiang¹, Xu, Kewei¹, Lin, Tianxin¹, Liu, Hao¹, Yin, Zi², Dong, Wen¹, Huang, Hai¹, Huang, Jian¹

المصدر: BJU International. Mar2013, Vol. 111 Issue 4, p611-621. 11p. 1 Diagram, 5 Charts, 1 Graph.

مصطلحات موضوعية: *NEPHRECTOMY, *CANCER treatment, *RENAL cell carcinoma, *META-analysis, *KIDNEY surgery, *HEALTH outcome assessment, *TREATMENT effectiveness, LAPAROSCOPIC surgery complications

مستخلص: What's known on the subject? and What does the study add? Laparoscopic nephrectomy is now considered to be the reference procedure for kidney cancer. It can be performed via a transperitoneal or retroperitoneal approach. Each approach has its advantages and disadvantages. No definitive conclusions regarding objective difference between the two approaches have been reached to date., This meta-analysis indicates that in appropriately selected patients, especially patients with posteriorly located renal tumors, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach., Objective To evaluate the efficiency and safety of the retroperitoneal and transperitoneal approaches in laparoscopic radical/partial nephrectomy (RN/PN) for renal cell carcinoma., Methods A systematic search of PUBMED, EMBASE, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared the outcomes of the two approaches., Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables., Results Twelve studies assessing transperitoneal laparoscopic RN (TLRN) vs retroperitoneal laparoscopic RN (RLRN) and six studies assessing transperitoneal laparoscopic PN (TLPN) vs retroperitoneal laparoscopic PN (RLPN) were included., The RLRN approach had a shorter time to renal artery control (weighted mean difference [WMD] 68.65 min; 95% confidence interval [CI] 40.80-96.50; P < 0.001) and a lower overall complication rate (odds ratio 2.12; 95% CI 1.30-3.47; P = 0.003) than TLRN. RLPN had a shorter operating time (WMD 48.85 min; 95% CI 29.33-68.37; P < 0.001) and a shorter length of hospital stay (WMD 1.01 days; 95% CI 0.39-1.63; P = 0.001) than TLPN., There were no significant differences between the retroperitoneal and transperitoneal approaches in other outcomes of interest., Conclusions This meta-analysis indicates that, in appropriately selected patients, especially patients with posteriorly located renal tumours, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach., Despite our rigorous methodology, conclusions drawn from our pooled results should be interpreted with caution because of the inherent limitations of the included studies. [ABSTRACT FROM AUTHOR]

المؤلفون: Fan, Xinxiang¹, Lin, Tianxin¹, Xu, Kewei¹, Yin, Zi², Huang, Hai¹, Dong, Wen¹, Huang, Jian¹ yehjn@yahoo.com.cn

المصدر: European Urology. Oct2012, Vol. 62 Issue 4, p601-612. 12p.

مصطلحات موضوعية: *NEPHRECTOMY, *LAPAROSCOPIC surgery, *ENDOSCOPIC surgery, *SYSTEMATIC reviews, *META-analysis, *RANDOMIZED controlled trials, *COMPARATIVE studies

مستخلص: Abstract: Context: Laparoendoscopic single-site (LESS) surgery has increasingly been used to perform radical, partial, simple, or donor nephrectomy to reduce the morbidity and scarring associated with surgical intervention. Studies comparing LESS nephrectomy (LESS-N) and conventional laparoscopic nephrectomy (CL-N) have reported conflicting results. Objective: To assess the current evidence regarding the efficiency, safety, and potential advantages of LESS-N compared with CL-N. Evidence acquisition: We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the two techniques. Evidence synthesis: Two RCTs and 25 retrospective studies including a total of 1094 cases were identified. Although LESS-N was associated with a longer operative time (weighted mean difference [WMD]: 9.87min; 95% confidence interval [CI], 3.37–16.38; p =0.003) and a higher conversion rate (6% compared with 0.3%; odds ratio: 4.83; 95% CI, 1.87–12.45; p =0.001), patients in this group might benefit from less postoperative pain (WMD: −0.48; 95% CI, −0.95 to −0.02; p =0.04), lower analgesic requirement (WMD: −4.78mg; 95% CI, −8.59 to −0.97; p =0.01), shorter hospital stay (WMD: −0.32 d; 95% CI, −0.55 to −0.09; p =0.007), shorter recovery time (WMD: −5.08 d; 95% CI, −8.49 to −1.68; p =0.003), and better cosmetic outcome (WMD: 1.07; 95% CI, 0.67–1.48; p <0.00001). Perioperative complications, estimated blood loss, warm ischemia time, and postoperative serum creatinine levels of graft recipients did not differ significantly between techniques. Conclusions: LESS-N offers a safe and efficient alternative to CL-N with less pain, shorter recovery time, and better cosmetic outcome. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis. [Copyright &y& Elsevier]