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Retzius sparing robotic assisted radical prostatectomy vs. conventional robotic assisted radical prostatectomy: a systematic review and meta-analysis

Lookup NU author(s): Dr Ankur Mukherjee, Dr Prabhakar Rajan, Bhavan Rai

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Abstract

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Context: Retzius sparing robotic assisted radical prostatectomy appears to have better continence rates when compared to conventional robotic assisted radical prostatectomy, however, concern with high positive surgical margin rates exist. Objective: To systematically evaluate evidence comparing functional and oncological outcomes of retzius sparing robotic assisted radical prostatectomy and conventional robotic assisted radical prostatectomy. Evidence acquisition: The systematic review was performed in accordance with the Cochrane guidelines and the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Bibliographic databases searched were PubMed/MEDLINE, Cochrane central register of controlled trials—CENTRAL (in The Cochrane library—issue 1, 2018). We used the GRADE approach to assess the quality of the evidence. Evidence synthesis: The search retrieved 137 references through electronic searches of various databases. Six were included in the review. RS-RALP was associated with better early continence rates (≤ 1 month) (moderate quality evidence) (RR 1.72, 95% CI 1.27, 2.32, p 0.0005) and at 3 months (low quality evidence) (RR 1.39, 95% CI 1.03, 1.88, p 0.03). Time to continence recovery, number of pads used and pad weight are better with RS-RALP. Based on very low quality evidence, RS-RALP did not alter 6 and 12 months continence rates. Based on very low quality evidence, RS-RALP did not alter T2 positive margin rates (RR 1.67, 95% CI 0.91, 3.06, p 0.10) and T3 positive margin rates (RR 1.08, 95% CI 0.68, 1.70, p = 0.75). Short-term biochemical free survival appears to be similar between the two approaches. Based on low-quality evidence, RS-RALP did not alter overall and major complication rates. Conclusions: RS-RARP appears to have earlier continence recovery when compared to Con-RARP which does not come at a significant oncologic cost. Whilst there was a trend towards higher PSM rates with RS-RALP, this did not achieve statistical significance. Furthermore this trend appeared to be less pronounced with T3 disease, where the PSM rates are almost similar.

Publication metadata

Author(s): Phukan C, Mclean A, Nambiar A, Mukherjee A, Somani B, Krishnamoorthy R, Sridhar A, Rajan P, Sooriakumaran P, Rai BP

Publication type: Review

Publication status: Published

Journal: World Journal of Urology

Year: 2019

Online publication date: 14/05/2019

Acceptance date: 30/04/2019

ISSN (print): 0724-4983

ISSN (electronic): 1433-8726

Publisher: Springer Verlag

URL: https://doi.org/10.1007/s00345-019-02798-4

DOI: 10.1007/s00345-019-02798-4

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