A Comparsion Of Outcomes Between Intrafascial And Interfascial Nerve-sparing Radical Prostatectomy:A Systematic Review And Meta-analysis

Background: To systematically review the efficacy and safety of intrafascial versus interfascial nerve-sparing radical prostatectomy in the treatment of prostate cancer.Method: We systematically searched PubMed,Web of Science,Embase,Cochrane Library,CNKI,and Wang Fang for literature search(published from inception to December 23,2016;no language restrictions)comparing intrafascial and interfascial nerve-sparing radical prostatectomy.Our main endpoints were operative time,estimated blood loss,blood transfusion rate,postoperative catheteriza tion time,positive surgical margin rate,BPFS,continence rate,and potency rate.We assessed pooled data by use of a random-eff ects model.Result: Two RCTs and four retrospective cohort studies totaling 1,311 prostatic cancer patients(558 in intrafascial nerve-sparing radical prostatectomy(Group A)and 753 in interfascial nerve-sparing(Group B))were included.Compared with group B,group A showed statistically significant advantage in terms of postoperative catheterization time(OR=-0.14,95%CI [-0.23,-0.05],P=0.002),urinary continence recovery(3-mo/6-mo/12-mo urinary continence recovery after surgery,P<0.05),and potency rates(6-mo/12-mo potency rates after surgery,P<0.05).There were no significant difference between the two groups in operative time(MD=1.32,95%CI [-2.19,4.83],P=0.46),Estimated blood loss(MD=1.85,95%CI [-8.44,12.13],P=0.72),Blood transfusion rates(OR=0.50,95%CI [0.04,5.53],P=0.57),positive surgical margin rates(OR=1.29,95%CI [0.65,2.59],P=0.47),and biochemical progression-free survival rates 1 year postoperatively(OR=0.58,95%CI [0.24,1.43],P=0.24).In addition,according to the subgroup analysis,there was no significant difference between laparoscopic surgery and robotic surgery in recovery of continuous and potency.Conclusions: Two operative techniques have similar therapeutic effect and the patient's condition can be effectively controlled.Compared with interfascial nerve-sparing radical prostatectomy,intrafascial nerve-sparing radical prostatectomy showed shorter postoperative catheterization time,quicker recovery of continuous and better potency.However,for the quantity limitation of the involved studies,this conclusion still requires to be further proved by well-designed randomized controlled trials.