| Background and purpose:According to statistics from the World Health Organization,the global incidence of prostate cancer and related mortality are among the forefront of male malignant tumors.Traditionally,China has always been regarded as one of the countries with the lowest incidence of prostate cancer.However,with the improvement of the living standards of Chinese residents and the development of public health services,the incidence of prostate cancer has increased year by year.As prostate cancer screening is not yet universal,high-risk patients currently account for a relatively high proportion of new cases.At present,radical prostatectomy is the best initial treatment for localized prostate cancer,and its application in high-risk prostate cancer patients is gradually increasing.However,the best treatment plan for high-risk patients has not yet been fully unified.Among them,radical prostatectomy can enable high-risk prostate cancer patients to achieve considerable postoperative tumor-specific survival and avoid overtreatment.On this basis,further improving the quality of life of patients has also become a problem that needs to be resolved.With the accumulation of surgical experience and the deepening of the understanding of the local anatomy of the prostate,the preservation of the neurovascular bundles(NVB)during radical resection has also been used for the treatment of high-risk prostate cancer patients.This article aims to further improve the postoperative quality of life of high-risk prostate cancer patients,and discuss the effectiveness and safety of sparing neurovascular bundles during radical prostatectomy.Materials and methods:We searched randomized controlled studies(RCT),clinical case-control studies or cohort studies on the treatment of high-risk prostate cancer by sparing neurovascular bundles for radical prostatectomy on Pub Med/Medline database,Embase,Cochrane Library,Wanfang Database,CNKI,VIP,CBM,China Clinical Trial Registry,American Clinical Trial Registry through computer network database from the establishment of these databases to July 2020,manually searched recent 5 journals: Chinese Journal of Urology,Journal of Clinical Urology,Journal of Modern Urology,Chinese Journal of Oncology,and Chinese Journal of Endoscopic Urology.Two researchers independently screened according to the present criteria,and evaluated the quality of the literatures obtained by the final screening,and extracted the outcome data of continence recovery,erectile function recovery,and positive surgical margins.Statistical analysis was performed on the included results using Stata16 software,and the relative risk(RR)was used as the effect size and its 95% confidence interval(95% CI)to evaluate the postoperative curative effect,and the postoperative time was divided into subgroups,respectively.Analyze the impact of this operation on the continence function and the recovery of erectile function in high-risk prostate cancer patients;finally,the funnel chart,Begg’s and Egger’s tests are used to determine whether there is publication bias.Results:After screening the above databases,and according to the inclusion and exclusion criteria,6articles were finally included in the study,all of which were cohort studies,1 article was a prospective cohort study,and 5 articles were retrospective cohort studies;respectively by two researchers Independently use the NOS scale to evaluate the quality of the literature,with a full score of 9 stars,the final 2 articles have a quality score of 5★,3 articles have a quality evaluation score of 6★,and 1 article has a quality score of 7★;a total of 1898 cases of high-risk prostate in cancer patients,there were 1581 cases in the group of neurovascular bundle reserved during the operation and 317 cases in the non-reserved group.The results of Meta analysis by STATA 16.0software showed that the recovery of continence function at 3 months after operation,RR=1.32,95%CI [1.11,1.58],the results show that the continence function recovery of the reserved group is better than that of the non-reserved group at 3 months after surgery,p<0.05,the difference between the two groups is statistically significant;the recovery of continence function at 12 months after surgery,RR=1.13,95%CI [0.96,1.32] p=0.134>0.05,the results indicate that there is no statistically significant difference between the reserved group and the unreserved group at 12 months after surgery;RR=1.06 in the 24 months group after surgery,95%CI [0.97,1.16],p =0.222>0.05,the results showed that 24 months after surgery,there was no statistically significant difference between the continence function of the reserved group and the non-reserved group;the recovery of erectile function was 12 months after the operation Group,RR=1.98,95%CI[1.53,2.56],p <0.05,the results suggest that at 12 months after surgery,the possibility of erectile function recovery in the reserved group is 1.98 times that of the unreserved group,and the difference is statistically significant;In the latter 24 months group,RR=2.90,95%CI [1.76,4.77],p<0.05,the results indicate that at 24 months after surgery,the possibility of sexual function recovery in the reserved group is 2.9 times that of the unreserved group,and the difference is statistically significant Significance;positive surgical margins,RR=0.58,95%CI [0.46,0.73],p<0.05,the results showed that the positive rate of surgical margins in the preservation group was significantly lower than that of the non-preservation group,and the difference between the two groups was statistically significant significance.Conclusion:Sparing the neurovascular bundles during radical prostatectomy of high-risk prostate cancer patients is beneficial to the recovery of short-term urinary continence after surgery,but has no significant improvement in the recovery of urinary continence in the long-term(12 months or more after surgery);it is obviously beneficial to the recovery of postoperative sexual function;Sparing the neurovascular bundles can improve the positive surgical margins. |
