Critical Appraisal of Literature Comparing Minimally Invasive Extraperitoneal and Transperitoneal Radical Prostatectomy: A Systematic Review and Meta-analysis

Overview

Journal Arab J Urol

Date 2017 Dec 14

PMID 29234528

Citations 7

Authors

Panagiotis Kallidonis

Bhavan Prasad Rai

Hasan Qazi

Roman Ganzer

Minh Do

Anja Dietel

Evangelos Liatsikos

Nabi Ghulam

Iason Kyriazis

Jens-Uwe Stolzenburg

Affiliations

Soon will be listed here.

Abstract

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 ( < 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; < 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; = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; = 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; = 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.

Citing Articles

Baseline factors and surgical procedures affecting changes in lower urinary tract symptoms after robot-assisted radical prostatectomy: the impact of nerve-sparing.

Soda T, Otsuka H, Koike S, Okada T Int Urol Nephrol. 2023; 56(3):989-997.

PMID: 37907707 DOI: 10.1007/s11255-023-03859-9.

Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Purnomo S, Hamid A, Siregar M, Afriansyah A, Mirza H, Seno D Urol Res Pract. 2023; 49(5):285-292.

PMID: 37877876 PMC: 10646806. DOI: 10.5152/tud.2023.23008.

Experience with an innovative surgical approach: 321 cases modified extraperitoneal single-incision robot-assisted laparoscopic radical prostatectomy without dedicated PORT based on Da Vinci SI system.

Luo C, Yang B, Ou Y, Wei Y, Wang Y, Yuan J J Robot Surg. 2023; 17(4):1659-1667.

PMID: 36947295 DOI: 10.1007/s11701-023-01576-0.

Transperineal single-port robot-assisted radical prostatectomy with Si da Vinci surgical system: initial experience and description of technique.

Ni K, Xue D, Li G Transl Cancer Res. 2022; 10(11):4694-4701.

PMID: 35116324 PMC: 8799017. DOI: 10.21037/tcr-21-898.

The effect of peritoneal re-approximation on lymphocele formation in transperitoneal robot-assisted radical prostatectomy and extended pelvic lymphadenectomy.

Boga M, Sonmez M, Karamik K, Yilmaz K, Savas M, Ates M Turk J Urol. 2020; 46(6):460-467.

PMID: 32833618 PMC: 7608535. DOI: 10.5152/tud.2020.20255.

References

Siqueira Jr T, Mitre A, Duarte R, Nascimento H, Barreto F, Falcao E . Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?. Int Braz J Urol. 2010; 36(4):450-7. DOI: 10.1590/s1677-55382010000400008. View

Cathelineau X, Cahill D, Widmer H, Rozet F, Baumert H, Vallancien G . Transperitoneal or extraperitoneal approach for laparoscopic radical prostatectomy: a false debate over a real challenge. J Urol. 2004; 171(2 Pt 1):714-6. DOI: 10.1097/01.ju.0000103885.71434.02. View

Madi R, Daignault S, Wood D . Extraperitoneal v intraperitoneal robotic prostatectomy: analysis of operative outcomes. J Endourol. 2008; 21(12):1553-7. DOI: 10.1089/end.2007.9872. View

Goldsack J, Sonnad S . Changing trends in surgical research: an analysis of 30 years of collaborative practices. JAMA Surg. 2014; 149(8):873-4. DOI: 10.1001/jamasurg.2014.97. View

Gao Z, Wu J, Wang K, Wang L, Yang D, Shi L . Comparison of the extraperitoneal and transperitoneal laparoscopic radical prostatectomy. Chin Med J (Engl). 2007; 119(24):2125-8. View

Horstmann M, Vollmer C, Schwab C, Kurz M, Padevit C, Horton K . Single-centre evaluation of the extraperitoneal and transperitoneal approach in robotic-assisted radical prostatectomy. Scand J Urol Nephrol. 2011; 46(2):117-23. DOI: 10.3109/00365599.2011.637957. View

Hirst A, Agha R, Rosin D, McCulloch P . How can we improve surgical research and innovation?: the IDEAL framework for action. Int J Surg. 2013; 11(10):1038-42. DOI: 10.1016/j.ijsu.2013.09.016. View

Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V . EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2010; 59(1):61-71. DOI: 10.1016/j.eururo.2010.10.039. View

Rai B, Shelley M, Coles B, Biyani C, El-Mokadem I, Nabi G . Surgical management for upper urinary tract transitional cell carcinoma. Cochrane Database Syst Rev. 2011; (4):CD007349. DOI: 10.1002/14651858.CD007349.pub2. View

10.

Bivalacqua T, Schaeffer E, Alphs H, Mettee L, Wagner A, Su L . Intraperitoneal effects of extraperitoneal laparoscopic radical prostatectomy. Urology. 2008; 72(2):273-7. DOI: 10.1016/j.urology.2007.12.040. View

11.

Erdogru T, Teber D, Frede T, Marrero R, Hammady A, Seemann O . Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy using match-pair analysis. Eur Urol. 2004; 46(3):312-9. DOI: 10.1016/j.eururo.2004.05.004. View

12.

SCHUESSLER W, Schulam P, Clayman R, Kavoussi L . Laparoscopic radical prostatectomy: initial short-term experience. Urology. 1998; 50(6):854-7. DOI: 10.1016/S0090-4295(97)00543-8. View

13.

Porpiglia F, Terrone C, Tarabuzzi R, Billia M, Grande S, Musso F . Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy: experience of a single center. Urology. 2006; 68(2):376-80. DOI: 10.1016/j.urology.2006.02.039. View

14.

Hoznek A, Antiphon P, Borkowski T, Gettman M, Katz R, Salomon L . Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology. 2003; 61(3):617-22. DOI: 10.1016/s0090-4295(02)02415-9. View

15.

Atug F, Castle E, Woods M, Srivastav S, Thomas R, Davis R . Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other?. Urology. 2006; 68(5):1077-81. DOI: 10.1016/j.urology.2006.07.008. View

16.

Ruiz L, Salomon L, Hoznek A, Vordos D, Yiou R, De La Taille A . Comparison of early oncologic results of laparoscopic radical prostatectomy by extraperitoneal versus transperitoneal approach. Eur Urol. 2004; 46(1):50-4. DOI: 10.1016/j.eururo.2004.04.013. View

17.

Mitropoulos D, Artibani W, Graefen M, Remzi M, Roupret M, Truss M . Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2011; 61(2):341-9. DOI: 10.1016/j.eururo.2011.10.033. View

18.

Phinthusophon K, Nualyong C, Srinualnad S, Taweemonkongsap T, Amornvesukij T . Laparoscopic radical prostatectomy: transperitoneal laparoscopic radical prostatectomy versus extraperitoneal endoscopic radical prostatectomy. J Med Assoc Thai. 2008; 90(12):2644-50. View

19.

Stolzenburg J, Rabenalt R, Do M, Horn L, Liatsikos E . Modular training for residents with no prior experience with open pelvic surgery in endoscopic extraperitoneal radical prostatectomy. Eur Urol. 2005; 49(3):491-8. DOI: 10.1016/j.eururo.2005.10.022. View

20.

Atug F, Thomas R . Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: which one?. Minerva Urol Nefrol. 2007; 59(2):143-7. View