Retzius-sparing robot-assisted radical prostatectomy vs the standard approach: a systematic review and analysis of comparative outcomes.
Retzius-sparing
functional recovery
positive surgical margins
prostate cancer
radical prostatectomy
robotics
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
pubmed:
3
8
2019
medline:
10
7
2020
entrez:
3
8
2019
Statut:
ppublish
Résumé
To summarize the current evidence on Retzius-sparing (RS)-robot-assisted radical prostatectomy (RARP) and to compare its oncological, peri-operative and functional outcomes with those of standard retropubic RARP (S-RARP). After establishing an a priori protocol, a systematic electronic literature search was conducted in January 2019 using the Medline (via PubMed), Embase (via Ovid) and Cochrane databases. The search strategy relied on the 'PICO' (Patient Intervention Comparison Outcome) criteria and article selection was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only studies reporting the oncological and functional outcomes of RARP (as determined by type of procedure [RS-RARP vs S-RARP]) were considered for inclusion. Risk of bias and study quality were assessed. Finally, peri-operative and functional outcomes were recorded and analysed. A shorter operating time was associated with RS-RARP (weighted mean difference [WMD] 14.7 min, 95% confidence interval [CI] -28.25, 1.16; P = 0.03), whereas no significant difference was found in terms of estimated blood loss (WMD 1.45 mL, 95% CI -31.18, 34.08; P = 0.93). Also, no significant difference between the two groups was observed for overall (odds ratio [OR] 0.86, 95% CI 0.40, 1.85; P = 0.71) and major (Clavien >3; OR 0.88, 95% CI 0.30, 2.57) postoperative complications; however, the likelihood of positive surgical margins (PSMs) was lower for the S-RARP group (rate 15.2% vs 24%; OR 1.71, 95% CI 1.12, 2.60; P = 0.01). The cumulative analysis showed a statistically significant advantage for RS-RARP in terms of continence recovery at 1 month (OR 2.54, 95% CI 1.16, 5.53; P = 0.02), as well as at 3 months (OR 3.86, 95% CI 2.23, 6.68; P < 0.001), 6 months (OR 3.61, 95% CI 1.88, 6.91; P = 0.001), and 12 months (OR 7.29, 95% CI 1.89, 28.13; P = 0.004). Our analysis confirms that RS-RARP is a safe and feasible alternative to S-RARP. This novel approach may be associated with faster and higher recovery of continence, without increasing the risk of complications. One caveat might be the higher risk of PSMs, and this can be regarded as a current pitfall of the technique, probably related to an expected learning curve.
Types de publication
Comparative Study
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
8-16Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.
Références
Checcucci E, Amparore D, De Luca S, Autorino R, Fiori C, Porpiglia F. Precision prostate cancer surgery: an overview of new technologies and techniques. Minerva Urol Nefrol 2019 https://doi.org/10.23736/S0393-2249.19.03365-4
Schiffmann J, Haese A, Boehm K et al. Ten-year experience of robot-assisted radical prostatectomy: the road from cherry-picking to standard procedure. Minerva Urol Nefrol 2017; 69: 69-75
Gu X, Araki M, Wong C. Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP). Minim Invasive Ther Allied Technol 2015; 24: 364-71
Sridhar AN, Abozaid M, Rajan P et al. Surgical techniques to optimize early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer. Curr Urol Rep 2017; 18: 71
Porpiglia F, Bertolo R, Manfredi M et al. Total anatomical reconstruction during robot-assisted radical prostatectomy: implications on early recovery of urinary continence. Eur Urol 2016; 69: 485-95
Porreca A, D'agostino D, Dandrea M et al. Bidirectional barbed suture for posterior musculofascial reconstruction and knotless vesicourethral anastomosis during robot-assisted radical prostatectomy. Minerva Urol Nefrol 2018; 70: 319-25
Manfredi M, Fiori C, Amparore D, Checcucci E, Porpiglia F. Technical details to achieve perfect early continence after radical prostatectomy. Minerva Chir 2019; 74: 63-77. https://doi.org/10.23736/S0026-4733.18.07761-1
Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM. A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 2010; 58: 457-61
Galfano A, Di Trapani D, Sozzi F et al. Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥1 year of follow-up. Eur Urol 2013; 64: 974-80
Galfano A, Panarello D, Secco S et al. Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? Minerva Urol Nefrol 2018; 70: 408-13
Stonier T, Simson N, Davis J, Challacombe B. Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) vs standard RARP: it's time for critical appraisal. BJU Int 2019; 123: 5-7
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration. 2013
Higgins JPT, Altman DG, Gøtzsche PC et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
Sterne JA, Hernán MA, Reeves BC et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
Wells GA, Shea B, O'Connell D et al. The Newcastle Ottawa 1 Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
Clark HD, Wells GA, Huët C et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials 1999; 20: 448-52
Guyatt GH, Oxman AD, Vist GE et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-6
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13
Mistretta FA, Galfano A, Di Trapani E et al. Robot assisted radical prostatectomy in kidney transplant recipients: surgical, oncological and functional outcomes of two different robotic approaches. Int Braz J Urol 2018; 45: 262-72
Dalela D, Jeong W, Prasad MA et al. A Pragmatic randomized controlled trial examining the impact of the retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2017; 72: 677-85
Menon M, Dalela D, Jamil M et al. Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the retzius sparing and standard approaches. J Urol 2018; 199: 1210-7
Asimakopoulos AD, Topazio L, De Angelis M et al. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc 2019; 33: 2187-96
Lim SK, Kim KH, Shin TY et al. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 2014; 114: 236-44
Chang LW, Hung SC, Hu JC, Chiu KY. Retzius-sparing robotic-assisted radical prostatectomy associated with less bladder neck descent and better early continence outcome. Anticancer Res 2018; 38: 345-51
Eden CG, Mosconas D, Soares R. Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: the UK experience. J Clin Urol 2018; 11: 15-20
Sayyid RK, Simpson WG, Lu C, Terris MK, Klaassen Z, Madi R. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J Endourol 2017; 31: 1244-50
Autorino R, Porpiglia F, Dasgupta P et al. Precision surgery and genitourinary cancers. Eur J Surg Oncol 2017; 43: 893-908
Yossepowitch O, Briganti A, Eastham JA et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 2014; 65: 303-13
Borregales LD, Berg WT, Tal O et al. ‘Trifecta’ after radical prostatectomy: is there a standard definition? BJU Int 2013; 112: 60-7
Liss MA, Osann K, Canvasser N et al. Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient reported validated questionnaires. J Urol 2010; 183: 1464-8