Posterior musculofascial reconstruction in robotic?assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer: a Cochrane Review

AbstractObjectives

To assess the effects of posterior musculofascial reconstruction robotic-assisted laparoscopic prostatectomy (PR-RALP) compared to no posterior reconstruction during (S-RALP) for the treatment of clinically localized prostate cancer.

Methods

We performed a systematic search with no restrictions including randomized controlled trials comparing variations of PR-RALP versus S-RALP for clinically localized prostate cancer. The quality of evidence was assessed on outcome basis according to Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

Main results

Our search identified thirteen records of eight unique randomized controlled trials, of which six were published studies, and two were abstract proceedings. There were 1085 randomized participants, of whom 963 completed the trials. All participants had either cT1c or cT2 or cT3a disease.

Primary outcomes

PR-RALP may improve urinary continence one week after catheter removal compared to no reconstruction (risk ratio (RR) 1.25, 95% confidence interval (CI) 0.90 to 1.73; I2 = 42%; studies = 5, participants = 498; low CoE).

PR-RALP may have little to no effect on urinary continence three months after surgery compared to no reconstruction (RR 0.98, 95% CI 0.84 to 1.14; I2 = 67%; studies = 6, participants = 842; low CoE).

PR-RALP probably results in little to no difference in serious adverse events compared to no reconstruction (RR 0.75, 95% CI 0.29 to 1.92; I2 = 0%; studies = 6, participants = 835; moderate CoE).

Conclusions

This review found evidence that PR-RALP may improve early continence one week after catheter removal but not thereafter. Meanwhile, adverse event rates are probably not impacted and surgical margins rates are likely similar. There was no difference in our subgroup analysis for all outcomes with anterior reconstruction technique when combined with posterior reconstruction versus only posterior reconstruction.