Intracorporeal Versus Extracorporeal Urinary Diversion Following Robotic-Assisted Radical Cystectomy for Bladder Cancer in Patients ≥ 65 Years of Age: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
There is scarce information regarding intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) for the treatment of bladder cancer in patients aged 65 and older. This review aims to investigate this literature gap. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, this systematic review and meta-analysis was prospectively registered with PROSPERO (registration number CRD42024620211). We searched PubMed, Scopus, and the Cochrane Library up to April 28, 2024, for any relevant literature comparing ICUD to ECUD in patients aged ≥65 years. We pooled the data using either weighted mean differences or odds ratios with random effects models. Heterogeneity was assessed with the Higgins I2 statistic, and the study quality was examined with the Newcastle-Ottawa scale. For results with moderate to high heterogeneity, we conducted a sensitivity analysis by excluding one study at a time. Nine studies with 4,340 patients in total, 1,967 in ICUD and 2,373 in ECUD, were included in the meta-analysis. The results showed that the ICUD significantly reduced the estimated blood loss (weighted mean differences (WMD): -64.34 mL, 95% CI: -113.26, -15.42; I² = 92%, p-heterogeneity < 0.00001, p-overall = 0.010), blood transfusion rates (OR: 0.29, 95% CI: 0.11, 0.76; I² = 86%, p-heterogeneity < 0.0001, p-overall = 0.01), and overall gastrointestinal complications (OR: 0.65, 95% CI: 0.46, 0.92; I² = 0%, p-heterogeneity = 0.70, p-overall = 0.02), when compared to ECUD, in patients 65 and over. However, we observed no significant differences, with regards to the operative duration (WMD: 3.48, 95% CI: -28.42, 35.38; I² = 98%, p-heterogeneity < 0.00001, p-overall = 0.83), length of hospitalization (WMD: 0.53, 95% CI: -0.15, 1.21; I² = 85%, p-heterogeneity < 0.00001, p-overall = 0.13), 30-day complication rates (OR: 1.22, 95% CI: 0.83, 1.78; I² = 77%, p-heterogeneity = 0.0005, p-overall = 0.30), 90-day complication rates (OR: 0.92, 95% CI: 0.61, 1.39; I² = 61%, p-heterogeneity = 0.04, p-overall = 0.68), or 30-day readmission rates (OR: 0.86, 95% CI: 0.62, 1.20; I² = 35%, p-heterogeneity = 0.20, p-overall = 0.38). The sensitivity analysis showed that several studies increased the heterogeneity, especially for results like the expected volume of blood loss and the transfusion rate. Overall, elderly patients undergoing robot-assisted radical cystectomy (RARC) may benefit from ICUD with regard to reduced blood loss, lower rates of blood transfusion, and decreased rate of gastrointestinal complications. However, more robust studies are required in order to reach firm findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.043 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".