Advertisement

Effects of Retzius sparing on robot-assisted laparoscopic prostatectomy: a systematic review with meta-analysis

  • Ting-En Tai
  • Chien-Chih Wu
  • Yi-No KangEmail author
  • Jeng-Cheng WuEmail author
Article
  • 139 Downloads

Abstract

Background

To comprehensively evaluate the efficacy and safety of Retzius sparing (RS) for men undergoing robot-assisted laparoscopic prostatectomy (RARP).

Methods

We searched four electronic databases and reference lists of relevant studies for eligible research published before March 11, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including positive surgical margin (PSM), continence, incontinence, complication, console time, and hospital stay.

Results

Two randomized clinical trials and four observational studies were included in this study. Quantitative syntheses revealed significantly higher PSM rates in RS-RARP compared with conventional RARP (c-RARP) (odds ratio [OR] 1.68, p = 0.02). Furthermore, we found significantly higher PSM rates at the anterior site in RS-RARP compared with c-RARP (OR 4.34, p = 0.03) and significantly lower incontinence rates in RS-RARP in the first month (OR 0.30, p < 0.001) and 12th month (OR 0.25, p < 0.001).

Conclusions

Our syntheses revealed higher PSM rates in the RS-RARP group, especially in the anterior aspect. However, RS-RARP had superior functional outcome of urinary continence and lower console time than did c-RARP with equivalent complication rates. Thus, we suggest that operators pay more attention to making clear surgical margins if the lesion is in anterior prostate when performing RS-RARP.

Keywords

Prostate cancer Prostatectomy Retzius sparing Robot-assisted Laparoscopic 

Abbreviations

CI

Confidence interval

c-RARP

Conventional robot-assisted laparoscopic radical prostatectomy

MD

Mean difference

OR

Odds ratio

RS-RARP

Retzius space-sparing robot-assisted laparoscopic prostatectomy

SD

Standard deviation

SE

Standard error

Notes

Acknowledgement

This manuscript was edited by Wallace Academic Editing.

Authors Contributions

TET conceptualized the study, screened the full text of the included studies, extracted the data, critically appraised the studies, drafted the manuscript, and approved the final manuscript; CCW interpreted the results, supervised the study, and approved the final manuscript; YNK designed the study, systematically searched the literature, screened the citations, extracted and analyzed the data, interpreted the results, drafted and critically revised the manuscript, and approved the final manuscript. JCW screened the full text of the included studies, checked the data, supervised the study, critically revised the manuscript, and approved the final manuscript.

Funding

No funding was requested for this systematic review and meta-analysis.

Disclosures

Ting-En Tai, Chien-Chih Wu, Yi-No Kang, and Jeng-Cheng Wu have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2019_7190_MOESM1_ESM.pdf (83 kb)
Supplementary material 1 (PDF 83 kb)
464_2019_7190_MOESM2_ESM.pdf (198 kb)
Supplementary material 2 (PDF 199b)

References

  1. 1.
    Jemal A, Center MM, DeSantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomark Prev 19:1893–1907CrossRefGoogle Scholar
  2. 2.
    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, Fossati N, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, Matveev VB, Moldovan PC, van den Bergh RCN, Van den Broeck T, van der Poel HG, van der Kwast TH, Rouviere O, Schoots IG, Wiegel T, Cornford P (2017) EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629CrossRefGoogle Scholar
  3. 3.
    Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR (1997) Laparoscopic radical prostatectomy: initial short-term experience. Urology 50:854–857CrossRefGoogle Scholar
  4. 4.
    Guillonneau B, Vallancien G (2000) Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 163:418–422CrossRefGoogle Scholar
  5. 5.
    Tooher R, Swindle P, Woo H, Miller J, Maddern G (2006) Laparoscopic radical prostatectomy for localized prostate cancer: a systematic review of comparative studies. J Urol 175:2011–2017CrossRefGoogle Scholar
  6. 6.
    Abbou CC, Hoznek A, Salomon L, Olsson LE, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D (2001) Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 165:1964–1966CrossRefGoogle Scholar
  7. 7.
    Tewari A, Peabody J, Sarle R, Balakrishnan G, Hemal A, Shrivastava A, Menon M (2002) Technique of da Vinci robot-assisted anatomic radical prostatectomy. Urology 60:569–572CrossRefGoogle Scholar
  8. 8.
    Jacobs EF, Boris R, Masterson TA (2013) Advances in robotic-assisted radical prostatectomy over time. Prostate Cancer 2013:902686CrossRefGoogle Scholar
  9. 9.
    Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58:457–461CrossRefGoogle Scholar
  10. 10.
    Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM (2013) 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 64:974–980CrossRefGoogle Scholar
  11. 11.
    Hemal AK, Menon M (2018) Robotics in genitourinary surgery. Springer, BerlinCrossRefGoogle Scholar
  12. 12.
    Asimakopoulos AD, Topazio L, De Angelis M, Agro EF, Pastore AL, Fuschi A, Annino F (2018) Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc 33(7):2187–2196CrossRefGoogle Scholar
  13. 13.
    Chang LW, Hung SC, Hu JC, Chiu KY (2018) Retzius-sparing robotic-assisted radical prostatectomy associated with less bladder neck descent and better early continence outcome. Anticancer Res 38:345–351PubMedGoogle Scholar
  14. 14.
    Dalela D, Jeong W, Prasad MA, Sood A, Abdollah F, Diaz M, Karabon P, Sammon J, Jamil M, Baize B, Simone A, Menon M (2017) 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 72:677–685CrossRefGoogle Scholar
  15. 15.
    Menon M, Dalela D, Jamil M, Diaz M, Tallman C, Abdollah F, Sood A, Lehtola L, Miller D, Jeong W (2018) 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 199:1210–1217CrossRefGoogle Scholar
  16. 16.
    Sayyid RK, Simpson WG, Lu C, Terris MK, Klaassen Z, Madi R (2017) Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J Endourol 31:1244–1250CrossRefGoogle Scholar
  17. 17.
    Stonier T, Simson N, Davis J, Challacombe B (2019) Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) vs standard RARP: it’s time for critical appraisal. BJU Int 123:5–7CrossRefGoogle Scholar
  18. 18.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–269):w264CrossRefGoogle Scholar
  19. 19.
    Chang SH, Kang YN, Chiu HY, Chiu YH (2018) A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest 153:1201–1212CrossRefGoogle Scholar
  20. 20.
    Kao CC, Lin YS, Chu HC, Fang TC, Wu MS, Kang YN (2018) Association of renal function and direct-acting antiviral agents for HCV: a network meta-analysis. J Clin Med 7:314CrossRefGoogle Scholar
  21. 21.
    Lin EY, Kuo YK, Kang YN (2018) Effects of three common lumbar interbody fusion procedures for degenerative disc disease: a network meta-analysis of prospective studies. Int J Surg (Lond, Engl) 60:224–230CrossRefGoogle Scholar
  22. 22.
    Lin TM, Chi JE, Chang CC, Kang YN (2019) Do etoricoxib and indometacin have similar effects and safety for gouty arthritis? A meta-analysis of randomized controlled trials. J Pain Res 12:83–91CrossRefGoogle Scholar
  23. 23.
    Chen LS, Chen WC, Kang YN, Wu CC, Tsai LW, Liu MZ (2019) Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc 33:418–428CrossRefGoogle Scholar
  24. 24.
    Huang YJ, Kang YN, Huang YM, Wu AT, Wang W, Wei PL (2019) Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: an update systematic review and meta-analysis of randomized controlled trials. Asian J Surg 42(6):657–666CrossRefGoogle Scholar
  25. 25.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clin Res Ed) 343:d5928CrossRefGoogle Scholar
  26. 26.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefGoogle Scholar
  27. 27.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clin Res Ed) 327:557–560CrossRefGoogle Scholar
  28. 28.
    Lim SK, Kim KH, Shin TY, Han WK, Chung BH, Hong SJ, Choi YD, Rha KH (2014) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 114:236–244CrossRefGoogle Scholar
  29. 29.
    Eden CG, Moschonas D, Soares R (2018) Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: the UK experience. J Clin Urol 11:15–20CrossRefGoogle Scholar
  30. 30.
    Koutlidis N, Duperron C, de la Vega MF, Mourey E, Michel F, Cormier L (2014) Capsular incision in normal prostatic tissue during robot-assisted radical prostatectomy: a new concept or a waste of time? World J Urol 32:1235–1240CrossRefGoogle Scholar
  31. 31.
    Philippou Y, Harriss E, Davies L, Jubber I, Leslie T, Bell RW, Bryant RJ, Hamdy FC, Verill C, Lamb AD (2018) Prostatic capsular incision during radical prostatectomy has important oncological implications. A systematic review and meta-analysis. BJU Int.  https://doi.org/10.1111/bju.14522 CrossRefPubMedGoogle Scholar
  32. 32.
    Kim LHC, Santok GD, Raheem AA, Alabdulaali I, Choi YD, Rha KH (2016) Incidence and location of positive surgical margin following Retzius-Sparing Robot-Assisted Radical Prostatectomy and its significance on oncological outcome. BJU Int 118:8Google Scholar
  33. 33.
    Dirie NI, Pokhrel G, Guan W, Mumin MA, Yang J, Masau JF, Hu H, Wang S (2018) Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis. Asian J Urol 6(2):174–182CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyTaipei Medical University HospitalTaipeiTaiwan, Republic of China
  2. 2.Department of Education and Humanities in Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan, Republic of China
  3. 3.Department of EducationTaipei Medical University HospitalTaipeiTaiwan, Republic of China
  4. 4.Institute of Health Policy and Management, College of Public HealthNational Taiwan UniversityTaipeiTaiwan, Republic of China
  5. 5.Evidence-Based Medicine CenterWan Fang Hospital, Taipei Medical UniversityTaipeiTaiwan, Republic of China
  6. 6.Department of Urology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan, Republic of China

Personalised recommendations