Retzius-sparing robot assisted radical prostatectomy (RARP) V.S. standard approach: A systematic review and analysis of comparative outcomes.

The aim of this systematic review is to summarize the current evidence on Retzius-Sparing robot-assisted radical prostatectomy (RZ-RARP) and to compare its oncological, perioperative, and functional outcomes to standard retropubic RARP (S-RARP).

After establishing an a priori protocol, a systematic electronic literature search was conducted in January 2019 using Medline (via PubMed), Embase (via Ovid), and Cochrane databases. The search strategy relied on the PICO criteria. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and was registered (PROSPERO registration number 131667). Only studies reporting the oncological and functional outcomes of RARP (as determined by type of procedure (RZ-RARP vs S-RARP)) were considered for inclusion. Risk of bias and quality of the study were assessed. Finally, perioperative and functional outcomes were recorded and analysed.

A shorter operative time was found for RZ-RARP (Weighted mean difference (WMD) 14.7 min; 95% CI -28.25, 1.16 min; p=0.03), whereas no significant difference was found in terms of estimated blood loss (WMD 1.45 mL; 95% CI -31.18, 34.08 mL; p=0.93). Also, no significant difference between the two groups was found for overall (OR 0.86; 95% CI 0.40, 1.85; p=0.71) and major (Clavien>3) (OR 0.88, 95% CI 0.30, 2.57) postoperative complications. However, the likelihood of PSMs was lower for the S-RARP group (rate 15.2% vs 24%; OR 1.71; 95% CI 1.12, 2.60; p=0.01). The cumulative analysis showed a statistically significant advantage for RZ-RARP in terms of continence recovery at 1 month (OR 2.54; 95% CI 1.16, 5.53; p=0.02), as well as at 3 months (OR 3.86; 95% CI 2.23, 6.68; p<0.001), 6 months (OR 3.61; 95% CI 1.88, 6.91; p=0.001), and 12 months (OR 7.29; 95% CI 1.89, 28.13; p=0.004).

Our analysis confirms that RZ-RARP is a safe and feasible alternative to S-RARP. This novel approach can be associated with faster and higher recovery of continence, without increasing the risk of complications. One caveat might be the higher risk of PSMs, and this can be regarded as a current pitfall of the technique, probably related to an expected learning curve. This article is protected by copyright. All rights reserved.

BJU international. 2019 Aug 02 [Epub ahead of print]

Enrico Checcucci, Alessandro Veccia, Cristian Fiori, Daniele Amparore, Matteo Manfredi, Michele Di Dio, Ivano Morra, Antonio Galfano, Riccardo Autorino, Aldo Massimo Bocciardi, Prokar Dasgupta, Francesco Porpiglia

Division of Urology, Dept. Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano (Turin), Italy., Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy., Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Division of Urology, VCU Health, Richmond, VA, USA., King's College London, Guy's Hospital, London, UK.