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This systematic review and meta-analysis will review randomized control trials for localized bladder cancer, evaluating surgical and pathologic outcomes of ORC versus RARC.
Methods:
Randomized studies evaluating adults with non-metastatic bladder cancer who underwent a radical cystectomy. Randomized trials were selected for final review. Data was extracted and analyzed with Revman 5 software. The primary outcome was complication rates within 90 days. Secondary outcomes included postoperative quality of life, estimated intraoperative blood loss, and other perioperative outcomes. Continuous variables were reported using mean difference with 95% confidence intervals, and dichotomous variables were reported using risk difference with 95% confidence intervals with RARC as the experimental group and ORC as the reference group.
Results:
Of 134 articles screened, six unique randomized studies were selected. For Grade I-II complications, the risk ratio (RR) was 0.92 (95% CI [0.79,1.08], p = 0.33), and for Grade III-V complications, RR 0.93 (95% CI [0.73,1.18], p = 0.59). RARC resulted in decreased blood loss (95% CI [−438.08, −158.44], p < 0.00001) and longer operative time (95% CI [55.23, 133.13], p < 0.00001). Quality of life using the EORTC-QLQ-30 global health score at 3 months post-op appeared to favor RARC with a mean difference of 4.46 points (95% CI [1.78, 7.15], p = 0.001). Pathologic outcomes neither statistically nor clinically favored one modality, as there was no significant difference between mean lymph node yield (p = 0.49), positive lymph nodes (p = 1.00), and positive surgical margins (p = 0.85) between the surgical modalities.
Conclusions:
Although one surgical modality is not overtly superior, the choice may be decided by mitigating individual operative risk factors like intraoperative blood loss, operative time, post-operative quality of life, as well as institutional costs and learning curve among surgeons.
On a cultural level, the Italian Renaissance lifted Europe into a new era of humanism that glorified humanity and shifted attention to the present needs and desires of people. Erasmus translated this humanistic attitude into scholarly pursuits that revealed the frailties and needs of the human authors of Scripture. All of these forces eroded the authority of the Church, leading to dramatic confrontation, both from inside and outside the Church. The Protestant Reformation took advantage of the rift between Christian monarchs and the papacy, successfully fragmenting the unity of Western Christendom. However, it was Copernicus who used the strategy and tools of reasoned arguments to arrive at his heliocentric theory of planetary motion. This bold assertion successfully demonstrated a truth arrived at through reason that differed from the conclusion supported by the authority of the Church. As a result, reason triumphed over faith, and the age of science began. While psychology remained obscured within philosophy and religion during this time, the enduring questions still perplexed scholars and were about to be addressed directly over two centuries of philosophical inquiries prior to psychology’s formal definition as a distinct science.
The chapter specifically explores the Futurist aesthetics of noise as manifested in Luigi Russolo’s ‘noise machines,’ or ‘intonarumori.’ Noise, and composition with noises, folds in with the Futurists’ general affirmation of technological modernity and with their related aesthetic practices extolling the virtues of speed, violence and war. The chapter also ponders Futurist noise and its relationship to twelve-tone dissonance, and discovers a common spiritualist thread linking these musical formal practices. For Russolo, at least, the technical and spiritualist connections relate to Leonardo da Vinci’s own plans for music machines, and his general view art’s ‘spirituality.’
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