Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy: A systematic review and meta-analysis

TY - JOUR

T1 - Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy

T2 - A systematic review and meta-analysis

AU - Kallidonis, Panagiotis

AU - Rai, Bhavan Prasad

AU - Qazi, Hasan Abdur Rahman

AU - Ganzer, Roman

AU - Do, Minh

AU - Dietel, Anja

AU - Liatsikos, Evangelos

AU - Nabi, Ghulam

AU - Kyriazis, Iason

AU - Stolzenburg, Jens Uwe

N1 - Open Access funded by Arab Association of Urology

PY - 2017/12

Y1 - 2017/12

N2 - Objectives: To systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP). Methods: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6. months. Results: In all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of -0.30. days (95% confidence interval [CI] -0.35, -0.24) for the laparoscopic group and 1.09. days (95% CI -1.47, -0.70) for the robotic group (P <. 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; P <. 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; P = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; P = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; P = 0.01). Conclusion: This review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.

AB - Objectives: To systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP). Methods: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6. months. Results: In all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of -0.30. days (95% confidence interval [CI] -0.35, -0.24) for the laparoscopic group and 1.09. days (95% CI -1.47, -0.70) for the robotic group (P <. 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; P <. 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; P = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; P = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; P = 0.01). Conclusion: This review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.

KW - Extraperitoneal

KW - Laparoscopy

KW - Minimally invasive

KW - Prostatectomy

KW - Robotic

KW - Transperitoneal

U2 - 10.1016/j.aju.2017.07.003

DO - 10.1016/j.aju.2017.07.003

M3 - Review article

C2 - 29234528

AN - SCOPUS:85028625763

SN - 2090-598X

VL - 15

SP - 267

EP - 279

JO - Arab Journal of Urology

JF - Arab Journal of Urology

IS - 4

ER -