Comparison of efficacy of Retzius-sparing radical prostatectomy versus standard radical prostatectomy in the treatment of prostate cancer: a systematic review and meta-analysis

摘要

Objective: To compare the efficacy of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) versus standard robot-assisted radical prostatectomy (S-RARP) in treating prostate cancer patients regarding urinary continence (UC) recovery, oncological control, and other complications. Methods: , 2024. The main outcomes were UC recovery positive, positive surgical margin (PSM), biochemical recurrence (BCR) and postoperative complications. Result robustness was enhanced based on the RoB and quality assessments. Results: The final analysis included 3 randomized controlled trials, 2 prospective studies, and 4 retrospective studies. According to quantitative results, RS-RARP improved the UC recovery rates at catheter removal (OR=11.33, 95% CI=[1.29-99.69], P=0.03), at 1 month (OR=14.18, 95% CI=[1.34-150.44], P=0.03), 3 months (OR=3.64, 95% CI=[1.94-6.83], P<0.00001), 6 months (OR=3.18, 95% CI=[1.62-6.22], P=0.0007), but failed to present a better continence recovery rate at 12 months (OR=2.30, 95% CI=[0.77-6.85], P=0.14) postoperatively. The RS-RARP group presented higher overall PSM rates (OR=1.51, 95% CI=[1.15-1.98]) and PSM rates in ≥ pT3 tumors (OR=1.81, 95% CI=[1.18-2.77], P=0.006) versus the S-RARP group. Furthermore, the two groups did not present obviously different BCR rates (OR=0.58, 95% CI=[0.20-1.67], P=0.31), operating time (WMD=10.41 min, 95% CI=[-2.82-23.65], P=0.12), intraoperative estimated blood loss (WMD=-15.97 mL, 95% CI=[-41.53-9.58], P=0.22), serious postoperative complications (OR=1.04, 95% CI=[0.50-2.13], P=0.10). Conclusions: Our meta-analysis revealed that although RS-RARP demonstrated accelerated urinary continence recovery, it showed a tendency toward higher PSM rates in patients with ≥pT3 tumors.