Perioperative and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy vs. conventional robot-assisted radical prostatectomy: evidence based on randomized-controlled trials

The objective of this research is to evaluate and contrast the clinical effectiveness and perioperative results of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) against those of conventional robot-assisted laparoscopic radical prostatectomy (C-RARP). Data sources including PubMed, Google Scholar, and Embase were systematically searched, covering the period from the inception of each database through to December 20, 2024. Relevant literature concerning the clinical comparison between RS-RARP and C-RARP was collected, with only RCTs included. The retrieved literature was initially screened based on predefined eligibility criteria for inclusion and exclusion. The methodological quality of the eligible studies was assessed., and relevant research data were subsequently extracted. Finally, RevMan 5.4 software was utilized for the meta-analysis of the research data. The outcomes of the meta-analysis included robotic intervention time, operation time, estimated blood loss, unilateral and bilateral neuroprotection rates, lymph-node dissection rate, positive surgical margin rate, immediate urinary control rate, and tumor recurrence rate. A total of seven randomized-controlled trials (RCTs) were analyzed, featuring 848 participants, with 420 in the RS-RARP group and 428 in the C-RARP group. The findings from the meta-analysis showed that there were no significant differences in age, PSA levels, BMI, intraoperative blood loss, rates of unilateral and bilateral nerve preservation, lymph-node dissection, positive surgical margins, total complications, and rates of biochemical recurrence between the RS-RARP and C-RARP groups. However, considerable differences were noted regarding robot-assisted intervention time, overall operation duration, and the rate of immediate postoperative recovery of urinary control between the two groups. Both RS-RARP and C-RARP offer benefits to individuals with prostate cancer. RS-RARP demonstrates superiority over C-RARP in robotic intervention time, operation time, and immediate postoperative urinary control recovery rate. The quantity of studies included in this meta-analysis is relatively few, and the sample size is limited. Therefore, large-scale, prospective, further high-quality RCTs are required to confirm these findings.