Comparing Retzius-sparing and conventional robot-assisted radical prostatectomy for men with localized prostate cancer

This review compared the outcomes of 2 techniques for robotic-assisted radical prostatectomy (RARP; complete removal of the prostate gland using robotic arms): Retzius-sparing (RS)-RARP and conventional (C)-RARP in patients with localized prostate cancer (PCa). The analysis showed that RS-RARP was associated with improved urinary function compared to C-RARP, but with a higher risk of leaving cancer cells behind. 

PCa is a common cancer in men. Radical prostatectomy (RP) is one of the commonly used procedures to treat PCa. It involves the complete removal of the prostate gland and some tissue around it. RP can be removed through a classic, open surgery, or laparoscopically (Lap).

In open surgery, the prostate is removed through a large incision. During Lap RP, the surgeon makes a few small cuts and uses special tools including a camera to remove the prostate. Lap RP had become more common as it reduces complications and reduces bleeding and recovery time. RARP is a type of Lap RP where the surgeon uses robotic arms to remove the prostate and surrounding tissue.

A major complication after RP is loss of urinary function such as urinary incontinence (UI; urine leakage) and erectile dysfunction (ED; inability to get and maintain an erection). A newer procedure called Retzius-sparing (RS) RARP has been developed to reduce these complications. RS-RARP preserves certain urinary structures that are commonly removed through conventional (C) RARP. The outcomes of RS- and C-RARP have been previously compared in patients with localized PCa, but the results were conflicting. Therefore, it is important to evaluate whether RS-RARP improves to outcomes of patients with localized PCa compared to C-RARP.

This analysis included 13 studies with a total of  2,917 patients with localized PCa that received either RS-RARP or C-RARP. The outcomes of the patients were compared. 

UI was evaluated 1, 3, 6, and 12 months after catheter (urinary tube) removal. At 1, 3, and 6 months RS-RARP showed a significantly better UI recovery rate than C-RARP.

Positive surgical margins (PSM) are a marker of successful cancer surgery. PSM refers to cancer cells left behind after surgery. If PSM exists, there is a risk of cancer relapse and spread. For patients with T2 PCa (cancer has not broken the prostate capsule), there was no difference in PSM between RS-RARP and C-RARP. However, in patients with larger tumors (T3; the cancer has penetrated the prostate capsule), C-RARP showed a 26% higher chance of no PSM compared to RS-RARP. 

The was no significant difference between the 2 procedures in regard to blood loss, recovery time, and complication rate.

This study showed that RS-RARP has better urinary function recovery outcomes than C-RARP but C-RARP has better outcomes regarding PSM in more advanced cases. The authors suggested that caution should be taken with patients with high-risk disease. 

This study analyzed very different studies, with different methodologies. Sexual function was not evaluated. Surgical techniques may have also been different. Further studies are needed to compare the 2 RARP methods. 

Discuss with your urologist which procedure is more appropriate in your situation.