Xu Jiang-Nan, Xu Zhen-Yu, Yin Hu-Ming
Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Urology, Kunshan Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China.
Front Surg. 2021 Sep 30;8:738421. doi: 10.3389/fsurg.2021.738421. eCollection 2021.
The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial. A research was conducted in Medline PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis. A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22-4.16, = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56-9.19, < 0.01), 3 months (OR = 6.44, 95% CI: 4.50-9.22, < 0.01), 6 months (OR = 8.68, 95% CI: 4.01-18.82, < 0.01), and 12 months (OR = 2.37, 95% CI: 1.20-4.70, = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = -16.28, 95% CI: -27.04 to -5.53, = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19-0.67, = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function. Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.
保留耻骨后间隙的机器人辅助根治性前列腺切除术（RS-RARP）在尿控方面显示出更好的效果，但其与传统机器人辅助根治性前列腺切除术（c-RARP）相比的疗效和安全性仍存在争议。截至2021年1月4日，在医学文献数据库（Medline）、PubMed、考克兰图书馆、EMBASE和科学网进行了一项研究，以确定比较RS-RARP和c-RARP的研究。我们使用RevMan 5.3和STATA 14.0进行荟萃分析。总共纳入了14项研究，涉及3129名参与者。荟萃分析显示，手术切缘阳性（PSM）方面无显著差异，但RS-RARP组在前部区域的PSM率显著更高[比值比（OR）=2.25，95%置信区间（CI）：1.22-4.16，P=0.01]。RS-RARP组术后1个月（OR=5.72，95%CI：3.56-9.19，P<0.01）、3个月（OR=6.44，95%CI：4.50-9.22，P<0.01）、6个月（OR=8.68，95%CI：4.01-18.82，P<0.01）和12个月（OR=2.37，95%CI：1.20-4.70，P=0.01）的尿控情况明显优于c-RARP组。此外，RS-RARP组的控制台操作时间更短（平均差值=-16.28，95%CI：-27.04至-5.53，P=0.003），疝气发生率更低（OR=0.35，95%CI：0.19-0.67，P=0.001）。然而，在估计失血量、盆腔淋巴结清扫率、术后并发症、1年生化复发率和术后性功能方面无显著差异。与c-RARP相比，RS-RARP显示出更好的尿控恢复、更短的控制台操作时间和更低的疝气发生率。虽然总体PSM无显著差异，但我们建议，如果病变位于前列腺前部，外科医生应更加谨慎。
