Transperitoneal versus extraperitoneal robot-assisted radical prostatectomy for localized prostate cancer.
- Author:
Chen-Zhao HUA
1
;
Zhong-Lin CAI
2
;
Wen-Juan LI
3
;
Chuan ZHOU
4
;
Xu-Pan WEI
1
;
Hai-di LÜ
1
;
Feng-Hai ZHOU
1
Author Information
1. Department of Urology, Lanzhou General Hospital, Gansu, Lanzhou 730050, China.
2. The Second School of Clinical Medicine of Lanzhou University, Gansu, Lanzhou 730000, China.
3. Department of Urology, West China Hospital, Chengdu, Sichuan 610041, China.
4. School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, China.
- Publication Type:Journal Article
- Keywords:
extraperitoneal;
meta-analysis;
prostate cancer;
prostatectomy;
robot-assisted radical prostatectomy;
transperitoneal
- MeSH:
Blood Loss, Surgical;
Case-Control Studies;
Humans;
Male;
Margins of Excision;
Operative Time;
Postoperative Complications;
Prostatectomy;
adverse effects;
methods;
Prostatic Neoplasms;
pathology;
surgery;
Randomized Controlled Trials as Topic;
Robotic Surgical Procedures;
adverse effects;
methods;
Treatment Outcome
- From:
National Journal of Andrology
2017;23(6):540-549
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical effects of transperitoneal (Tp) versus extraperitoneal (Ep) robot-assisted radical prostatectomy (RARP) in the treatment of localized prostate cancer.
METHODS:We searched PubMed, EMBASE, Web of Science, EBSCO, Cochrane Library, Wanfang, CNKI, and CBM for the articles comparing the clinical effect Tp-RARP with that of Ep-RARP in the treatment of localized prostate cancer published from January 2000 to November 2016. All the articles must meet the inclusion criteria, that is, dealing with at least one of the following aspects: operation time, intraoperative blood loss, postoperative catheterization time, length of bed confinement, perioperative complications, positive surgical margins, bowel-related complications, postoperative anastomotic leakage, and postoperative urinary continence. We subjected the data obtained to statistical analysis using the RevMan5.3 software.
RESULTS:Two randomized controlled trials and six case-control studies were included in this meta-analysis, involving 451 cases of Tp-RARP and 676 cases of Ep-RARP. Compared with Tp-RARP, Ep-RARP showed significantly shorter operation time (WMD = 21.39, 95% CI: 7.54－35.24, P = 0.002), shorter length of bed confinement (WMD = 0.85, 95% CI: 0.61－1.09, P <0.001), and lower rate of bowel-related complications (RR = 9.74, 95% CI: 3.26－29.07, P <0.001). However, no statistically significant differences were found between the two strategies in intraoperative blood loss (WMD = －8.12, 95% CI: －27.86－11.63, P = 0.42), postoperative catheterization time (WMD = 0.17, 95% CI: －0.55－0.21, P = 0.38), or the rates of perioperative complications (RR = 1.34, 95% CI: －0.97－1.87, P = 0.08), positive surgical margins (RR = 1.24, 95% CI: 0.95－1.61, P = 0.12), anastomotic leakage (RR = 0.98, 95% CI: 0.46－2.10, P = 0.95), urinary continence at 3 months (RR = 0.96, 95% CI: 0.91－1.00, P = 0.05) and urinary continence at 6 months (RR = 1.00, 95% CI: 0.97－1.02, P = 0.82).
CONCLUSIONS:Ep-RARP has the advantages of shorter operation time, shorter length of bed confinement and lower rate of bowel-related complications over Tp-RARP, and therefore may be a better option for the treatment of localized prostate cancer. However, more multi-centered randomized controlled clinical trials are needed for further evaluation of these two approaches.
