Gong Weilun, Yan Junfeng, Cui Yilun, Zhang Duojie, Ma Yinfeng
Department of Urology, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China.
Department of Urology, Zhejiang Hospital, Hangzhou, Zhejiang, China.
Front Oncol. 2025 May 14;15:1547687. doi: 10.3389/fonc.2025.1547687. eCollection 2025.
To compare the efficacy of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) versus standard robot-assisted radical prostatectomy (S-RARP) in treating prostate cancer patients regarding urinary continence (UC) recovery, oncological control, and other complications.
An electronic search was performed on four databases with no restrictions on the language up to May 16, 2024. The main outcomes were UC recovery positive, positive surgical margin (PSM), biochemical recurrence (BCR) and postoperative complications. Result robustness was enhanced based on the RoB and quality assessments.
The final analysis included 3 randomized controlled trials, 2 prospective studies, and 4 retrospective studies. According to quantitative results, RS-RARP improved the UC recovery rates at catheter removal (OR=11.33, 95% CI=[1.29-99.69], P=0.03), at 1 month (OR=14.18, 95% CI=[1.34-150.44], P=0.03), 3 months (OR=3.64, 95% CI=[1.94-6.83], P<0.00001), 6 months (OR=3.18, 95% CI=[1.62-6.22], P=0.0007), but failed to present a better continence recovery rate at 12 months (OR=2.30, 95% CI=[0.77-6.85], P=0.14) postoperatively. The RS-RARP group presented higher overall PSM rates (OR=1.51, 95% CI=[1.15-1.98]) and PSM rates in ≥ pT3 tumors (OR=1.81, 95% CI=[1.18-2.77], P=0.006) versus the S-RARP group. Furthermore, the two groups did not present obviously different BCR rates (OR=0.58, 95% CI=[0.20-1.67], P=0.31), operating time (WMD=10.41 min, 95% CI=[-2.82-23.65], P=0.12), intraoperative estimated blood loss (WMD=-15.97 mL, 95% CI=[-41.53-9.58], P=0.22), serious postoperative complications (OR=1.04, 95% CI=[0.50-2.13], P=0.10).
Our meta-analysis revealed that although RS-RARP demonstrated accelerated urinary continence recovery, it showed a tendency toward higher PSM rates in patients with ≥pT3 tumors.
比较保留耻骨后间隙机器人辅助根治性前列腺切除术（RS-RARP）与标准机器人辅助根治性前列腺切除术（S-RARP）在治疗前列腺癌患者时，在尿失禁（UC）恢复、肿瘤学控制及其他并发症方面的疗效。
截至2024年5月16日，对四个数据库进行了无语言限制的电子检索。主要结局指标为UC恢复阳性、手术切缘阳性（PSM）、生化复发（BCR）及术后并发症。基于风险偏倚（RoB）和质量评估增强了结果的稳健性。
最终分析纳入3项随机对照试验、2项前瞻性研究和4项回顾性研究。根据定量结果，RS-RARP提高了拔除导尿管时（比值比[OR]=11.33，95%置信区间[CI]=[1.29 - 99.69]，P=0.03）、术后1个月（OR=14.18，95% CI=[1.34 - 150.44]，P=0.03）、3个月（OR=3.64，95% CI=[1.94 - 6.83]，P<0.00001）、6个月（OR=3.18，95% CI=[1.62 - 6.22]，P=0.0007）的UC恢复率，但术后12个月（OR=2.30，95% CI=[0.77 - 6.85]，P=0.14）未显示出更好的尿失禁恢复率。与S-RARP组相比，RS-RARP组总体PSM率更高（OR=1.51，95% CI=[1.15 - 1.98]），≥pT3期肿瘤的PSM率更高（OR=1.81，95% CI=[1.18 - 2.77]，P=0.006）。此外，两组的BCR率（OR=0.58，95% CI=[0.20 - 1.67]，P=0.31）、手术时间（加权均数差[WMD]=10.41分钟，95% CI=[-2.82 - 23.65]，P=0.
