Meta-analysis Of Transperitoneal Versus Extraperitoneal Robot-assisted Laparoscopic Radical Prostatectomy For Prostate Cancer

Objective: Conducting a meta-analysis of studies to compare the efficacy and safety of transperitoneal and extraperitoneal robot-assisted laparoscopic radical prostatectomy(RALRP)for treating prostate cancer.Methods: A systematic literature search of articles that comparing Tp-RALRP with Ep-RALRP from January 2000 to November2016 was conducted via Pub Med,EMBASE,EBSCO,Cochrane library,Wan fang,CNKI,CBM,at the same time,by manual search of journals related to urology and andrology.According to the inclusion and exclusion criteria,two researchers screen all the articles independently and choose the appropriate articles,then assess the quality of them and extract the related data,finally,use Rev Man5.3 software to analyze all the outcomes including operation time,blood loss,catheterization time,length of stay,time of postoperative intestinal function recovery,perioperative complications,complications related to bowel,rate of positive surgical margin,anastomotic Leakage rate,urinary continence.Results: Two hundred and twenty-four studies were searched out initially,via Pub Med,EMBASE,EBSCO,Cochrane library,there were thirty-six,eighty-eight,seventy and nine studies respectively;while via Wan fang,CNKI,CBM,there were nine,six and nine studies respectively,while through other approach,no articles were searched out.Eight studies were identified that met the inclusion criteria,including two randomized controlled trial and six case-control studies.Within these studies,676 patients underwent Ep-RALRP,and 451 patients underwent Tp-RALRP.After all the studies were analyzed,we found that between Tp-RALRP and Ep-RALRP,significant difference existed in operation time(WMD=21.39,95%CI 7.54~35.24,P=0.002),length of stay(WMD=0.4,95%CI 0.25~0.56,P=0.01),the rate of perioperative complications(OR=1.93,95%CI 1.30~2.87,P=0.001),the rate of complications related to bowel(OR=10.45,95%CI 3.42~31.92,P<0.0001),the urinary continence after removing the catheter immediately(OR=0.63,95%CI 0.42~0.95,P=0.03)and urinary continence at 3 month(OR=0.36,95%CI 0.13~0.98,P=0.05).While there were no significant difference in blood loss during operation(WMD=16.34,95%CI-24.81~57.50,P=0.44),catheterization time after operation(WMD=0.19,95%CI-0.60~0.98,P=0.64),time of postoperative intestinal function recovery(WMD=0.14,95%CI-0.35~0.63,P=0.57),rate of positive surgical margin(OR=1.31,95%CI 0.93~1.85,P=0.12),anastomotic Leakage rate(OR=0.98,95%CI 0.43~2.20,P=0.95)and urinary continence at 6 month(OR=0.79,95%CI 0.11~5.66,P=0.81).Conclusion: Ep-RALRP held advantages in operation time,length of stay,the rate of perioperative complications,the rate of complications related to bowel,the urinary continence after removing the catheter immediately and urinary continence at 3 month.Therefore,compared with Tp-RALRP,Ep-RALRP could be a more suitable approach in treating prostate cancer.More random clinical trials that are large-sample and followed up longly are needed in the future to better evaluate these two approaches.