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Minerva Urology and Nephrology 2021 Oct 29

DOI: 10.23736/S2724-6051.21.04623-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Systematic review comparing Anterior vs Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference?

Simone ALBISINNI 1 , Cyrielle DASNOY 1, Romain DIAMAND 2, Georges MJAESS 3, Fouad AOUN 2, 3, Francesco ESPERTO 4, Francesco PORPIGLIA 5, 6, Cristian FIORI 5, 6, Thierry ROUMEGUÈRE 1, 2, Cosimo DE NUNZIO 7

1 Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium; 2 Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium; 3 Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon; 4 Urology Department, Università Campus Biomedico, Rome, Italy; 5 Division of Urology- San Luigi Hospital (Orbassano), Turin; 6 Department of Oncology, University of Turin, Turin, Italy; 6 Urology Department, Sant’Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy


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INTRODUCTION: Retzius-Sparing Robotic Assisted Radical Prostatectomy (RS-RARP) is a novel surgical approach to radical prostatectomy. Its pioneers have suggested an improved recovery of urinary continence, while maintaining adequate cancer control. Aim of this systematic review is to explore available data on RS-RALP and compare functional, oncologic and perioperative results of RS-RARP compared to anterior RARP.
EVIDENCE ACQUISITION: A search following PRISMA guidelines was performed including the combination of the following words: retzius AND sparing AND radical AND prostatectomy. 93 articles were identified and 13 were included in the systematic review, including 3 randomized controlled trials (RCT), 4 prospective studies and 6 retrospective studies.
EVIDENCE SYNTHESIS: All available randomized trials confirmed an improved immediate continence for RS-RARP, with rates ranging 51-71%, compared to 21-48% for anterior RARP. However, this advantage was progressively lost with no significant difference found after 6 months. Moreover, a prospective study found no discrepancy in terms of quality of life across the two techniques. Erectile function was difficult to compare, as patients had different baseline erectile function across studies and rate of neurovascular preservation was not comparable. Surgical approach remains controversial regarding positive margin rate, although related to the surgeon’s experience and clinical stage. Biochemical recurrence-free survival appears similar between the two approaches.
CONCLUSIONS: RS-RARP improves early urinary continence recovery compared to anterior RARP, with this advantage being lost after 3 to 6 months. Erectile function and quality of life were however comparable between the two techniques. The results concerning the rate of positive margins remained controversial. Future studies with longer follow-up are needed to better assess oncologic outcomes.


KEY WORDS: Prostate cancer; Prostatectomy; Robotic; Retzius-sparing

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