Kallidonis Panagiotis, Rai Bhavan Prasad, Qazi Hasan, Ganzer Roman, Do Minh, Dietel Anja, Liatsikos Evangelos, Ghulam Nabi, Kyriazis Iason, Stolzenburg Jens-Uwe
Department of Urology, University of Leipzig, Leipzig, Germany.
Department of Urology, University of Patras, Patras, Greece.
Arab J Urol. 2017 Aug 31;15(4):267-279. doi: 10.1016/j.aju.2017.07.003. eCollection 2017 Dec.
To systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP).
The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6 months.
In all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of -0.30 days (95% confidence interval [CI] -0.35, -0.24) for the laparoscopic group and 1.09 days (95% CI -1.47, -0.70) for the robotic group ( < 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; < 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; = 0.01).
This review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.
系统评价比较腹膜外（E-RP）与经腹膜微创根治性前列腺切除术（T-RP）的研究。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，于2015年9月进行系统评价。检索了包括Medline和Scopus在内的多个数据库。仅评估比较E-RP和T-RP（腹腔镜或机器人辅助方法）的研究。纳入患者的随访时间必须≥6个月。
初步数据库检索后共识别出1256条记录。其中20项研究（2580例患者）符合纳入标准。E-RP队列的住院时间显著更短，腹腔镜组的平均差异为-0.30天（95%置信区间[CI]-0.35，-0.24），机器人组为1.09天（95%CI-1.47，-0.70）（P<0.001）。早期控尿率有利于E-RP组，尽管仅在腹腔镜组中具有统计学意义（优势比[OR]2.52，95%CI1.72，3.70；P<0.001）。对于腹腔镜组（OR1.55，95%CI0.89，2.69；P=0.12）和机器人组（OR3.03，95%CI0.54，16.85；P=0.21），E-RP和T-RP队列的12个月控尿率无统计学显著差异。E-RP队列中腹腔镜组和机器人组的总体并发症和肠梗阻发生率均显著更低。有症状的淋巴囊肿发生率有利于T-RP队列，尽管仅在腹腔镜组中具有统计学意义（OR8.69，95%CI1.60，47.17；P=0.01）。
本评价表明，与经腹膜途径相比，腹膜外途径与更短的住院时间、更低的总体并发症发生率以及更早恢复控尿相关。经腹膜途径的淋巴囊肿发生率更低。
