Simultaneous robotic-assisted prostatectomy and rectal resection: a systematic review

Prostate cancer (PC) and rectal cancer (RC) are common and can require complex management, especially when presenting synchronously or with invasive characteristics. Robotic surgery has emerged as a viable option for managing these challenging cases; however, the outcomes are yet to be summarised or compared to traditional approaches. This systematic review aims to evaluate the feasibility, oncological outcomes, and functional results of simultaneous robotic-assisted resections of the prostate and rectum. Following prior protocol registration (PROSPERO: CRD42023449872) and according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, we conducted a systematic search across multiple databases, selecting studies that involved simultaneous bladder-sparing robotic-assisted prostatectomy and rectal resection. The Joanna Briggs Institute tool was used for risk of bias assessment. Data on patient demographics, treatment details, post-operative course, and functional and oncological outcomes were extracted and analysed. From 1357 identified records, 25 studies met our inclusion criteria resulting in 45 cases/patients. The median patient age was 62 years. Diverse treatment backgrounds and outcome definitions were recorded. Median operative time was 548 min and median estimated blood loss was 450 mL. The overall complication rate was 44.4%, with major complications (Clavien-Dindo III) occurring in 17.8% of cases. Surgical margins were negative in 92.6% of cases. Continence recovery occurred for most (78.6%) of the cases reporting on urinary function. Simultaneous robotic-assisted prostatectomy and rectal resection appears to be a feasible, safe and oncologically effective approach with satisfactory oncological and functional outcomes for managing patients with synchronous or invasive PC and RC.