Effects of Retzius sparing on robot-assisted laparoscopic prostatectomy: a systematic review with meta-analysis
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To comprehensively evaluate the efficacy and safety of Retzius sparing (RS) for men undergoing robot-assisted laparoscopic prostatectomy (RARP).
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.
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).
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.
KeywordsProstate cancer Prostatectomy Retzius sparing Robot-assisted Laparoscopic
Conventional robot-assisted laparoscopic radical prostatectomy
Retzius space-sparing robot-assisted laparoscopic prostatectomy
This manuscript was edited by Wallace Academic Editing.
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.
No funding was requested for this systematic review and meta-analysis.
Ting-En Tai, Chien-Chih Wu, Yi-No Kang, and Jeng-Cheng Wu have no conflicts of interest or financial ties to disclose.
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