Anatomic Factors Associated with Complications After Radical Prostatectomy: A Systematic Review and Meta-analysis.
作者信息
Peyrottes Arthur, Dariane Charles, Baboudjian Michael, Barret Eric, Brureau Laurent, Fiard Gaelle, Fromont Gaelle, Mathieu Romain, Olivier Jonathan, Renard-Penna Raphaëlle, Roubaud Guilhem, Rouprêt Morgan, Sargos Paul, Supiot Stéphane, de la Taille Alexandre, Turpin Léa, Desgrandchamps François, Ploussard Guillaume, Masson-Lecomte Alexandra
机构信息
Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Saint-Louis Hospital, Paris-Cité University, Paris, France.
Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Hôpital Européen Georges Pompidou, AP-AP, Paris, France; U1151 Inserm-INEM, Paris-Cité University, Paris, France.
出版信息
Eur Urol Oncol. 2025 Apr;8(2):554-570. doi: 10.1016/j.euo.2024.10.018. Epub 2024 Nov 18.
BACKGROUND AND OBJECTIVE
The role of anatomical factors in predicting outcomes after radical prostatectomy (RP) remains unclear. This review aims to evaluate the impact of various anatomical factors on the perioperative outcomes of patients undergoing RP for localized prostate cancer (PCa).
METHODS
A comprehensive literature search was conducted through January 2024 using the PubMed/Medline, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. Data were extracted and pooled for a meta-analysis, with outcomes including operative time, blood loss, transfusion rates, overall complications, and positive surgical margins (PSMs). Heterogeneity was assessed using Cochrane Q test, and subgroup analyses were conducted to explore the influence of surgical approach.
KEY FINDINGS AND LIMITATIONS
A total of 91 studies met our inclusion criteria. Among the anatomical factors, prostate volume (PV), prostate weight, and median lobe (ML) were suitable for the meta-analysis. Larger prostates were associated with increased operative time, blood loss, and complication rates, but with fewer PSMs (all p < 0.05). ML presence was not associated with a higher risk of complications. Heterogeneity was high across studies (Cochrane Q tests <0.05), reflecting inconsistent definitions and methods. In subgroup analyses, the open approach was associated with a longer operative time than robotic surgery for large prostates (p = 0.03) and a lower PSM rate (p < 0.001).
CONCLUSIONS AND CLINICAL IMPLICATIONS
Anatomical factors, particularly PV, play a significant role in RP outcomes. Larger prostates are associated with higher complication rates but fewer PSMs. Further research with standardized outcome measures is necessary to clarify these relationships and guide clinical decision-making.
PATIENT SUMMARY
In this study, we examined how a patient's individual anatomy might affect the results of prostate surgery for cancer. We found that larger prostates tend to lead to longer surgeries and increased blood loss, but these also have a lower risk of leaving cancer cells behind. These findings could help doctors in better planning surgeries and improving patient outcomes.
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