Purnomo Stefanus, Hariandy Hamid Agus Rizal Ardy, Roemare Siregar Moammar Andar, Afriansyah Andika, Mirza Hendy, Seno Doddy Hami, Purnomo Nugroho
Department of Urology, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Jakarta, Indonesia.
Department of Surgery, Persahabatan General Hospital - Universitas Indonesia, Faculty of Medicine, Division of Urology, Jakarta, Indonesia.
Urol Res Pract. 2023 Sep;49(5):285-292. doi: 10.5152/tud.2023.23008.
To conduct a comparative analysis of outcomes from 2 different surgical approaches, transperitoneal radical prostatectomy (TP-RP) and extraperitoneal radical prostatectomy (EP-RP) in minimally invasive surgery. A comprehensive search was conducted up to September 2022 using 5 online databases, namely PubMed, Cochrane, Scopus, EMBASE, and Science Direct. Studies were screened per the eligibility criteria, and outcomes included operative duration, estimated blood loss (EBL), hospital stay, operative complication, and positive surgical margin. Total of 13 studies compiled of 2387 patients were selected, with TP-RP and EP-RP performed on 1117 (46.79%) and 1270 (53.21%) patients, respectively. Six laparoscopy radical prostatectomy (LRP) studies and 7 robotassisted radical prostatectomy (RARP) studies with 1140 and 1247 patients, respectively, were also included. The EP-RP demonstrated a marked advantage in terms of operative complications (Risk Ratio [RR]=0.78, 95% CI=0.62, 0.98; P=.04), but no significant difference concluded for operative duration, EBL, hospital stay, and surgical margin. In the RARP group, there was a significant difference in operative duration for EP-RARP and TP-RARP (Mean difference [MD]=-17.27, 95% CI=-26.89, -7.65; P=.0004), hospital stay (MD=-0.54, 95% CI=-0.94, -0.14; P=.008), and operative complications (RR=0.7, 95% CI=0.49, 0.99; P=.04). There were no noteworthy variations identified in EBL and surgical margin. Furthermore, the LRP group did not show any significant differences. This study shows that regardless of the techniques used, EP-RP has a lower risk of operative complications than TP-RP, with no significant difference in other outcomes.
为了对微创外科手术中两种不同手术方式——经腹根治性前列腺切除术（TP-RP）和腹膜外根治性前列腺切除术（EP-RP）的结果进行比较分析。截至2022年9月，使用5个在线数据库，即PubMed、Cochrane、Scopus、EMBASE和ScienceDirect进行了全面检索。根据纳入标准对研究进行筛选，结果包括手术持续时间、估计失血量（EBL）、住院时间、手术并发症和手术切缘阳性。共选择了13项研究，涉及2387例患者，其中分别对1117例（46.79%）和1270例（53.21%）患者进行了TP-RP和EP-RP手术。还纳入了6项腹腔镜根治性前列腺切除术（LRP）研究和7项机器人辅助根治性前列腺切除术（RARP）研究，分别涉及1140例和1247例患者。EP-RP在手术并发症方面显示出显著优势（风险比[RR]=0.78，95%可信区间[CI]=0.62，0.98；P=0.04），但在手术持续时间、EBL、住院时间和手术切缘方面未得出显著差异。在RARP组中，EP-RARP和TP-RARP的手术持续时间（平均差[MD]=-17.27，95%CI=-26.89，-7.65；P=0.0004）、住院时间（MD=-0.54，95%CI=-0.94，-0.14；P=0.008）和手术并发症（RR=0.7，95%CI=0.49，0.99；P=0.04）存在显著差异。EBL和手术切缘未发现明显差异。此外，LRP组未显示任何显著差异。本研究表明，无论采用何种技术，EP-RP的手术并发症风险均低于TP-RP，其他结果无显著差异。
