Robot-assisted Laparoscopic Radical Prostatectomy: A Meta-analysis Of Transperitoneal Versus Extraperitoneal Approach

Objective:To evaluate the efficacy and safty of robot-assisted laparoscopic radical prostatectomy for the localized prostate cancer performed between extraperitoneal and transperitoneal approach.Methods:Comprehensive retrieval the published literature in PubMed,the Cochrane Library,Web of Science,CNKI,VIP and Wanfang database by computer and manual retrieval the relevant contents in the library as well.The retrieval time was from the establishment date to December 2016.The data were screened and extracted by two researchers independently in our research group according to the search strategy and the inclusion / exclusion criteria.A consensus was reached through the discussion or the participation of the third researcher when there is a disagreement between the two researchers.Evaluate the quality of research and performed a Meta analysis by RevMan5.3 software.Results:A total of 8 articles were included in this Meta analysis,two of which were randomized controlled trials and the other six were case-control study.Within these studies,676 cases adopt E-RALRP and 451 cases adopt T-RALRP.The Meta analysis showed: the operative time for E-RALRP was shorter than for T-RALRP(WMD,-19.22;95%CI,-28.70~-9.74;p<0.0001);there was no significant difference in intraoperative blood loss between E-RALRP and T-RALRP(WMD,-8.84;95%CI,-45.68~27.99;p=0.64);for the margin positivity there was no significant difference between E-RALRP and T-RALRP(OR,0.86;95%CI,0.61~1.20;p=0.37);the length of stay for E-RALRP was shorter than for T-RALRP(WMD,-0.65;95%CI,-1.25~-0.05;p=0.04);the postoperative complications for E-RALRP was shorter than for T-RALRP(O R,0.48;95%CI,0.32~0.72;p=0.0004);there was a statistical difference in postoperative intestinal complications between E-RALRP and T-RALRP(OR,0.13;95%CI,0.04~0.45;p=0.001);there was no significant difference in postoperative catheter time between E-RALRP and T-RALRP(WMD,-0.19;95%CI,-0.98~-0.60;p=0.64);for postoperative urinary continence rates immediately,in three month,in six month,there was no significant difference between E-RALRP and T-RALRP,the parameter immediately was(O R,2.00;95%CI,0.57~7.08;p=0.28);the parameter in three month was(OR,1.59;95%CI,0.74~3.44;p=0.24)and the parameter in six month was(OR,1.46;95%CI,0.58~3.70;p=0.43).Conclusion:Robot-assisted extraperitoneal laparoscopic radical prostatectomy is an safe and effective method in the treatment of localized prostate cancer,moreover,it has more advantages to patients in the operation time,hospitalization time,postoperative complications and postoperative intestinal than traditional surgery.C linically,we can choose the best approach via the patient’s condition and medical level.