Cao Song, Wang Chong-Jian, Chen Cai-Xia, Li Hong-Yuan, Huang Hao-Tian, Jiang Lin-Han, Yang Xue-Song
Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Health Management Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
J Robot Surg. 2025 May 27;19(1):243. doi: 10.1007/s11701-025-02400-7.
The objective of this research was to evaluate the perioperative results, complications, and oncological outcomes associated with two distinct surgical methods for the treatment of recurrent prostate cancer: salvage robotic-assisted prostatectomy and salvage open prostatectomy. Our methodology concerned a complete search of major databases, along with PubMed, Web of Science, the Cochrane Library and Embase, covering studies published in all kinds of languages up to November 2024. Additionally, we omitted papers that included conference summaries and lacked relevance to our research. Various variables were assessed by employing weighted mean difference (WMD) and odds ratio (OR) metrics. The meta-analyses of the diverse parameters were carried out using Review Manager. Additionally, this study was registered with PROSPERO and the registration number is CRD42025632172. This meta-analysis encompassed three trials, comprising a total of 510 participants. The findings revealed that salvage robot-assisted prostatectomy (sRARP) had a longer operative time (WMD 13.88, 95% CI 3.94, 23.82; p = 0.006) and a lower rate of postoperative vesicourethral anastomotic stricture (OR 0.44, 95% CI 0.23-0.83; p = 0.01) compared to salvage open prostatectomy (sORP). However, no massive variations had been determined between the two surgical techniques regarding hospital stay, estimated blood loss, transfusion rate, complications, and oncological outcomes. In the context of recurrent prostate cancer, sRARP demonstrated superiority over sORP in reducing the rate of vesicourethral anastomotic stricture. Nonetheless, it is crucial to acknowledge that there were no significant disparities between the two techniques in terms of hospital stay, blood loss, transfusion requirements, complication rates, and oncological results. These insights suggest that robotic-assisted prostatectomy may offer certain advantages for patients undergoing salvage prostatectomy, but these benefits are not conclusive and warrant further validation through larger-scale, high-quality randomized controlled trials.
本研究的目的是评估与两种不同的复发性前列腺癌手术治疗方法相关的围手术期结果、并发症和肿瘤学结局：挽救性机器人辅助前列腺切除术和挽救性开放性前列腺切除术。我们的方法包括全面检索主要数据库，以及PubMed、科学网、考克兰图书馆和Embase，涵盖截至2024年11月以各种语言发表的研究。此外，我们排除了包含会议摘要且与我们的研究无关的论文。通过采用加权平均差（WMD）和比值比（OR）指标评估各种变量。使用Review Manager对不同参数进行荟萃分析。此外，本研究已在PROSPERO注册，注册号为CRD42025632172。这项荟萃分析包括三项试验，共有510名参与者。研究结果显示，与挽救性开放性前列腺切除术（sORP）相比，挽救性机器人辅助前列腺切除术（sRARP）的手术时间更长（WMD 13.88，95%CI 3.94，23.82；p = 0.006），术后膀胱尿道吻合口狭窄率更低（OR 0.44，95%CI 0.23 - 0.83；p = 0.01）。然而，在住院时间、估计失血量、输血率、并发症和肿瘤学结局方面，两种手术技术之间未发现重大差异。在复发性前列腺癌的背景下，sRARP在降低膀胱尿道吻合口狭窄率方面优于sORP。尽管如此，必须承认，在住院时间、失血量、输血需求、并发症发生率和肿瘤学结果方面，两种技术之间没有显著差异。这些见解表明，机器人辅助前列腺切除术可能为接受挽救性前列腺切除术的患者提供某些优势，但这些益处并不确凿，需要通过更大规模、高质量的随机对照试验进行进一步验证。
