三维与二维腹腔镜根治性前列腺切除术围手术期、肿瘤学及功能结局的比较：一项系统评价与荟萃分析

Comparison of perioperative, oncologic, and functional outcomes between 3D and 2D laparoscopic radical prostatectomy: a systemic review and meta-analysis.

作者信息

Shuai Hui, Duan Xi, Wu Tao

机构信息

Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.

Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.

出版信息

Front Oncol. 2023 Sep 19;13:1249683. doi: 10.3389/fonc.2023.1249683. eCollection 2023.

DOI:10.3389/fonc.2023.1249683

PMID:37795432

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10546177/

Abstract

OBJECTIVES

Literature regarding experience with 3D laparoscopy about prostatectomy has remained scanty, and this could be related to the rise of robotic assisted laparoscopic surgery. This study aimed to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between 3D and 2D laparoscopic radical prostatectomy (LRP).

METHODS

We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared perioperative, functional, or oncologic outcomes of both 3D and 2D LRP. The Newcastle-Ottawa Scale (NOS) tool and Jadad scale were used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis.

RESULTS

Seven studies with a total of 542 patients were included in the analysis. Among them, two were RCTs. There was no difference between groups in terms of preoperative characteristics. Anastomosis time, hospital day, and overall complication rates were similar in 3D than 2D group. However, operative time [mean difference (MD) -36.96; 95% confidence interval [CI] -59.25 to -14.67; p = 0.001], blood loss (MD -83.5; 95% CI -123.05 to -43.94; p <0.0001), and days of drainage (MD -1.48; 95% CI -2.29 to -0.67; p = 0.0003) were lower in 3D LRP. 2D and 3D LRP showed similarity in the positive surgical margin (PSM) rate and biochemical recurrence (BCR) rate at 3, 6, and 12months postoperatively. Additionally, there was no significant differences in continence and potency recovery rate between two group except higher continence rate of 3D LRP at 3 months.

CONCLUSION

Current evidence shows that 3D LRP offers favorable outcomes compared with 2D LRP, including operative time, blood loss, days of drainage, and early continence. However, there was no conclusive evidence that 3D LRP was advantaged in terms of oncologic and functional outcomes (except for continence rate at 3 months).

SYSTEMATIC REVIEW REGISTRATION

The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023426403).

摘要

目的

关于3D腹腔镜前列腺切除术经验的文献仍然很少，这可能与机器人辅助腹腔镜手术的兴起有关。本研究旨在进行系统评价和荟萃分析，以评估3D与2D腹腔镜根治性前列腺切除术（LRP）在围手术期、功能和肿瘤学方面的结局。

方法

我们系统检索了PubMed、Embase和Cochrane图书馆数据库，以查找比较3D和2D LRP围手术期、功能或肿瘤学结局的研究。采用纽卡斯尔-渥太华量表（NOS）工具和Jadad量表评估纳入研究的偏倚风险。使用Review Manager 5.3进行荟萃分析。

结果

分析纳入了7项研究，共542例患者。其中，2项为随机对照试验。两组术前特征无差异。3D组与2D组相比，吻合时间、住院天数和总体并发症发生率相似。然而，3D LRP的手术时间[平均差（MD）-36.96；95%置信区间（CI）-59.25至-14.67；p = 0.001]、失血量（MD -83.5；95% CI -123.05至-43.94；p <0.0001）和引流天数（MD -1.48；95% CI -2.29至-0.67；p = 0.0003）较低。2D和3D LRP在术后3、6和12个月的手术切缘阳性（PSM）率和生化复发（BCR）率方面相似。此外，两组间的控尿和性功能恢复率无显著差异，只是3D LRP在3个月时的控尿率较高。