Comparison of efficacy of Retzius-sparing radical prostatectomy versus standard radical prostatectomy in the treatment of prostate cancer: a systematic review and meta-analysis

Weilun Gong¹Junfeng Yan²Yilun Cui¹Duojie Zhang³Yinfeng Ma^1*

• ¹Department of Urology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Jiangsu Province, China
• ²Department of Urology, Zhejiang Hospital, Hangzhou, China
• ³Department of Urology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China

Objective: 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. Methods: An electronic search was performed on four databases with no restrictions on the language up to May 16 th , 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. evidence: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. * Upgraded one level due to objective findings, rigorous methodology, large effect size.‡ Downgraded one level due to confounding bias for studies without describing potential confounders control.§ Downgraded two levels due to the small number of events and the wide CI.