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).
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.
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).
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.
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.
European urology oncology. 2024 Nov 18 [Epub ahead of print]
Arthur Peyrottes, Charles Dariane, Michael Baboudjian, Eric Barret, Laurent Brureau, Gaelle Fiard, Gaelle Fromont, Romain Mathieu, Jonathan Olivier, Raphaëlle Renard-Penna, Guilhem Roubaud, Morgan Rouprêt, Paul Sargos, Stéphane Supiot, Alexandre de la Taille, Léa Turpin, François Desgrandchamps, Guillaume Ploussard, Alexandra Masson-Lecomte, French Oncology Committee from the Association Française d’Urologie
Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Saint-Louis Hospital, Paris-Cité University, Paris, France. Electronic address: ., 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., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Nord Hospital, AP-HM, Marseille, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR S 1085, Pointe-à-Pitre, Guadeloupe, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Pathology, CHRU, Tours, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, CHU, Lille, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Radiology, Pitie-Salpétrière Hospital, Sorbonne University, AP-HP, Paris, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Medical Oncology, Institut Bergonié, Bordeaux, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Radiotherapy, Institut Bergonié, Bordeaux, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France., Department of Urology, University Hospital Henri Mondor, AP-HP, Créteil, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Nuclear Medicine, Foch Hospital, Suresnes, 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, La Croix-du-Sud clinic, Quintes-Fonssegrives, France., Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Saint-Louis Hospital, Paris-Cité University, Paris, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/39562217