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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Anatomic Factors Associated with Complications After Radical Prostatectomy: A Systematic Review and Meta-analysis.

Arthur Peyrottes¹, Charles Dariane², Michael Baboudjian³

¹Comité de Cancérologie de l'Association Française d'Urologie, Paris, France; Department of Urology, Saint-Louis Hospital, Paris-Cité University, Paris, France.

European Urology Oncology

|November 19, 2024

Summary

Anatomical factors like prostate volume significantly impact radical prostatectomy outcomes. Larger prostates increase operative time and complications but reduce positive surgical margins, aiding surgical planning.

Keywords:

Adverse events Median lobe Meta-analysis Operative time Prostate cancer Prostate volume Radical prostatectomy Surgical complications Surgical margins Systematic review

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Area of Science:

Urology
Surgical Oncology
Medical Anatomy

Background:

The influence of anatomical variations on radical prostatectomy (RP) outcomes is not well-defined.
Understanding these factors is crucial for predicting perioperative results in localized prostate cancer (PCa).

Purpose of the Study:

To systematically review and meta-analyze the impact of anatomical factors on perioperative outcomes following RP for PCa.
To identify specific anatomical predictors influencing surgical success and complications.

Main Methods:

A comprehensive literature search was performed across major databases (PubMed/Medline, Embase, Web of Science) up to January 2024.
Eligible studies were identified following PRISMA guidelines, with data pooled for meta-analysis.
Outcomes included operative time, blood loss, transfusion rates, complications, and positive surgical margins (PSMs).

Main Results:

Ninety-one studies were included. Larger prostate volume (PV) and weight correlated with increased operative time, blood loss, and complications (p < 0.05).
Increased PV and weight were also associated with a lower rate of positive surgical margins (PSMs) (p < 0.05).
Subgroup analysis indicated open surgery for large prostates had longer operative times and lower PSM rates compared to robotic approaches.

Conclusions:

Anatomical factors, especially prostate volume, are significant predictors of RP outcomes.
Larger prostates present a trade-off: higher complication risk but reduced likelihood of positive surgical margins.
Standardized outcome measures are needed for future research to refine clinical decision-making in RP.