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

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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.

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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

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Acknowledgement

This manuscript was edited by Wallace Academic Editing.

Funding

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

Author information

Author notes

  1. Ting-En Tai and Chien-Chih Wu have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China

    Ting-En Tai, Chien-Chih Wu & Jeng-Cheng Wu

  2. Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China

    Chien-Chih Wu

  3. Department of Education, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China

    Chien-Chih Wu & Jeng-Cheng Wu

  4. Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China

    Yi-No Kang

  5. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China

    Yi-No Kang

  6. Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China

    Jeng-Cheng Wu

Authors
  1. Ting-En Tai
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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.

Corresponding authors

Correspondence to Yi-No Kang or Jeng-Cheng Wu.

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Disclosures

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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Tai, TE., Wu, CC., Kang, YN. et al. Effects of Retzius sparing on robot-assisted laparoscopic prostatectomy: a systematic review with meta-analysis. Surg Endosc 34, 4020–4029 (2020). https://doi.org/10.1007/s00464-019-07190-2

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  • DOI: https://doi.org/10.1007/s00464-019-07190-2

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