Outcomes of Retzius-sparing versus conventional robot-assisted radical prostatectomy: A KSER update series systematic review and meta-analysis

Abstract

Background Robotic‐assisted radical prostatectomy(RARP) is widely used to surgically treat of localized prostate cancer. Among RARP, retzius-sparing techniques(RS-RARP) are implemented through douglas pouch, not the existing conventional approach(C-RARP). We conducted an updated systematic review and meta-analysis including recent published papers. Materials & methods Systematic review was performed following the PRISMA guideline. PubMed, EMBASE, and Cochrane Library were searched up to August 2021. We conducted meta-analysis as follows; Participants, patients with biopsy-proven PCa; Interventions, Patients underwent C-RARP or RS-RALP; Outcomes, comparison of continence recovery rate, positive surgical margins(PSM), complication, operation time and estimated blood loss(EBL) included for analysis. Results Thirteen studies with a total of 2917 patients were included for meta-analysis. Among them, three were randomized controlled trials (RCT) studies and the rest were non-RCT studies. Incontinence was analyzed with zero pad and safety pad, respectively. There showed a statistically significant advantage for RS-RARP in terms of continence recovery at 1 month(0 pad; OR 0.28, (0.16–0.47), safety-pad; OR 0.12 (0.07–0.22), p<0.001), as well as at 3 months(0 pad; OR 0.31 (0.18–0.53), safety-pad; OR 0.23 (0.14–0.40) p<0.001), 6 months(0 pad; OR 0.29 (0.17–0.51), safety-pad; OR 0.13 (0.06–0.27), p<0.001). And after 12 months, RS-RARP showed better results only in the safety-pad(0 pad; OR 0.64 (0.35–1.18), p = 0.15, safety-pad; OR 0.12 (0.04–0.36), p<0.001). In PSM, there was no statistical difference between two group at overall stage, but RS-RARP was observed to be higher than C-RARP in pT3 subgroup analysis(OR 0.74 (0.55–0.99), p = 0.047) (Fig 1). Whereas, there was no significant difference between the two groups in complication, operation time, and EBL. Conclusions Our analysis showed that RS-RARP is superior about early continence recovery than C-RARP. However, RS-RARP showed relatively high PSM in locally advanced PCa of pT3 or above. Therefore, although RS-RARP has few advantages about functional outcomes, we think that caution should be exercised when approaching patients with high-risk local diseases.

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

“…Notably, more than 20 publications in the latest 4 years were comprehensive, narrative, systematic, and or meta-analytic literature reviews of the studies comparing anterior (or standard) to posterior (or Retzius-sparing) prostatectomy. Table 2[29 ▪▪ ,30–33,34 ▪▪ ,35–39,40 ▪ ] summarizes the most important findings of the 11 systematic reviews, confirming the role of RS-RARP in providing better immediate urinary continence recovery. Some of these reviews confirmed the advantage of RS-RARP on late continence recovery.…”

Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements

“…16 To date, eight systematic reviews and meta-analyses investigated the role of RS-RARP. [22][23][24][25][26][27][28][29] It merit mention the systematic review by Checcucci et al that reported comparable surgical outcomes and no significant difference in overall complications. 22 RS-RARP showed higher PSM rate (24% vs 15%), mainly in anterior tumors, but when the analysis was stratified for pT stage, there were similar rates for pT3 disease.…”

Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy

“…Focusing on the pT3 subgroup, RS-RARP is superior to the conventional group in terms of continence recovery ( P = 0.047). It should be highlighted that the RS-RARP was associated with a high rate of positive surgical margin (PSM) in this advanced group of patients, OR = 0.74[0.55, 0.99] favoring non-Retzius sparing RARP [26]. Therefore, in high-risk localized diseases, RS-RARP should be offered with caution, even though there could be a potential benefit to continence outcomes [27].…”