Comparison of efficacy and safety of conventional laparoscopic radical prostatectomy by the transperitoneal versus extraperitoneal procedure

Abstract

Worldwide, prostate cancer (PCa) is the second most common malignancy in males. We undertook a meta-analysis to compare the efficacy and safety of conventional laparoscopic radical prostatectomy with a transperitoneal (TLRP) approach, versus that of an extraperitoneal (ELRP) approach, for treatment of localized PCa. A comprehensive literature search retrieved 14 publications, with a total of 1715 patients. Meta-analysis of these studies showed that an ELRP approach was associated with a significantly shorter postoperative catheterization time (MD: 1.99; 95% CI: 0.52 to 3.54; P = 0.008), less blood transfusion rate (OR: 2.05; 95% CI: 1.03 to 4.06; P = 0.04), shorter intestinal function recovery time (MD: 0.08; 95% CI: 0.52 to 1.09; P < 0.0001) and shorter hospitalization days (MD: 2.71; 95% CI: 1.03 to 4.39; P = 0.002). In addition, our results showed no statistically significant differences between the two groups in operation time (MD: 19.39; 95% CI: −6.67 to 45.44; P = 0.014), intraoperative blood loss (MD: 4.89; 95% CI: −105.00 to 114.79; P = 0.93) and total complication rate (RR: 1.22; 95% CI: 0.86 to 1.74; P = 0.27). In summary, our meta-analysis showed that ELRP is likely to be a safe and feasible alternative for localized PCa patients compared with TLRP.

Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis

“…To our knowledge, this systematic review and meta-analysis is the first study to comprehensively evaluate this topic. The previous reviews or systematic reviews or meta-analysis evaluated the techniques of RP 5 , 18 – 20 (such as RARP, laparoscopic, and retropubic open), the PSM and perioperative complication rates of primary surgical treatments 21 , the primary surgical treatments for prostate cancer 22 – 26 , transperitoneal and extraperitoneal robot-assisted RP 27 , and the efficacy and safety of conventional laparoscopic RP with a transperitoneal approach versus that of an extraperitoneal approach 28 . Therefore, none of these studies focused on the surgical technique of RP.…”

Comparison of Perioperative, Functional, and Oncological Outcomes of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy

“…In terms of EBL, the transperitoneal patients had less blood loss than the extraperitoneal patients (800 mL vs. 400 mL, respectively, p < 0.001). Some other studies comparing EBL between E-LRP and T-LRP reported discrepancies; however, they found less blood loss, for which a possible explanation is the ergonomic space [19][20][21]. One possibility is an ergonomic space of the intraperitoneal cavity can exert enough pressure on the surrounding tissue to suppress bleeding, and one possible explanation for the signifcant diference in blood loss is that in the transperitoneal group, a considerable amount of blood was retained among the bowel loops.…”

A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution

“…Therefore, a preliminary conclusion can be drawn that more EBL is tightly associated with the transperitoneal route, similar results can be found in some previous studies which compare EBL between Ep-LRP and Tp-LRP (25-27). One possibility is that a self-made gas bag can make enough pressure on the surrounding tissue to lower the bleeding in extraperitoneal route (28).…”