Introduction and Aims: The optimal approach for nephroureterectomy in patients with suspected UTUC remains a point of debate. In this review, we compare the oncological outcomes of robotic nephroureterectomy (RNU) with open (ONU) or laparoscopic nephroureterectomy (LNU). Methods: All randomized trials and observational studies comparing RNU with ONU and/or LNU for suspected non-metastatic UTUC are included in this review. The systematic review was performed in accordance with the Cochrane Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IV-RFS). The secondary outcome measures were the lymph node dissection (LND) rates, positive margin rates, and the proportion of patients receiving bladder intravesical chemotherapy. Results: We identified 8172 references through our electronic searches and 8 studies through manual searching. A total of 15 studies met the inclusion criteria. The total number of patients in the review was 18,964. RNU had superior OS compared to LNU (HR: 0.81 (95% CI: 0.71, 0.93),p-0.002 (very low certainty)). RNU and ONU had similar OS (HR: 0.83 (95% CI: 0.52, 1.34),p-0.44 (very low certainty)). One study reported an independent association of RNU as a worse predictor of IV-RFS when compared to ONU (HR-1.73 (95% CI: 1.22, 2.45)). The LND rates were higher in the RNU cohort when compared to the LNU cohort (RR 1.24 (95% CI: 1.03, 1.51),p-0.03 (low certainty)). The positive margin rate was lower in the RNU cohort when compared to the ONU cohort (RR 0.29 (95% CI: 0.08, 0.86),p-0.03 (low certainty)). Conclusion: RNU offers comparable oncological efficacy to ONU, except for intravesical recurrence-free survival (IV-RFS). RNU has fewer positive surgical margin rates compared to ONU in well-balanced studies. RNU appears to outperform LNU for certain oncological parameters, such as OS and the proportion of patients who receive lymph node dissections. The quality of evidence comparing surgical techniques for UTUC has remained poor in the last decade.
引言与目的：对于疑似上尿路尿路上皮癌（UTUC）患者，肾输尿管切除术的最佳手术方式仍存在争议。本文综述旨在比较机器人辅助肾输尿管切除术（RNU）与开放（ONU）或腹腔镜肾输尿管切除术（LNU）的肿瘤学结局。方法：本综述纳入所有比较RNU与ONU和/或LNU治疗疑似非转移性UTUC的随机试验和观察性研究。系统评价遵循Cochrane指南及系统评价与荟萃分析优先报告条目（PRISMA）规范。主要结局指标包括总生存期（OS）、癌症特异性生存期（CSS）、无病生存期（DFS）及膀胱内无复发生存期（IV-RFS）。次要结局指标涵盖淋巴结清扫率、切缘阳性率以及接受膀胱内灌注化疗的患者比例。结果：通过电子检索获得8172篇文献，手工检索补充8篇，最终15项研究符合纳入标准，共涉及18,964例患者。与LNU相比，RNU具有更优的OS（风险比[HR]：0.81（95%置信区间[CI]：0.71, 0.93），p=0.002（证据质量极低））。RNU与ONU的OS相近（HR：0.83（95% CI：0.52, 1.34），p=0.44（证据质量极低））。一项研究报道，与ONU相比，RNU是IV-RFS的独立不良预测因素（HR=1.73（95% CI：1.22, 2.45））。与LNU组相比，RNU组的淋巴结清扫率更高（相对风险[RR] 1.24（95% CI：1.03, 1.51），p=0.03（证据质量低））。与ONU组相比，RNU组的切缘阳性率更低（RR 0.29（95% CI：0.08, 0.86），p=0.03（证据质量低））。结论：除膀胱内无复发生存期（IV-RFS）外，RNU与ONU的肿瘤学疗效相当。在均衡性良好的研究中，RNU的切缘阳性率低于ONU。在某些肿瘤学参数（如OS和淋巴结清扫率）方面，RNU的表现优于LNU。近十年来，比较UTUC手术技术的研究证据质量仍然较低。
肿瘤(癌症)患者之家