Abstract
In this meta-analysis study, we compared the oncological and functional outcomes of intrafascial radical prostatectomy (IFRP) with non-intrafascial radical prostatectomy (NIFRP) in the treatment of patients with low risk localized prostate cancer (PCa). Relevant articles were identified by searching PubMed, EMBASE, Cochrane Library, Ovid, and the ISI Web of Knowledge databases. A total of 2096 patients were included from 7 eligible studies. Results of the pooled data showed that the oncological outcomes including gleason score, positive surgical margin and biochemical free survival rates were similar between the two groups. IFRP was superior to NIFRP with lower postoperative complication rates (RR 0.57, 95% CI 0.38, 0.85, p = 0.006), higher continence rates at 3 months post-operation (RR: 1.14; 95% CI, 1.04, 1.26; p = 0.006), and higher potency rates at 6 months (RR: 1.53; 95% CI, 1.07, 2.18; p = 0.02) and 12 months post-operation (RR: 1.38; 95% CI, 1.11, 1.73; p = 0.005). Additionally, there was a tendency towards higher potency rate in patients ≤65 years old compared with patients >65 years old after IFRP. Overall, these findings suggest that IFRP in young patients with low risk localized PCa had less postoperative complications, shortened time to return to continence and improved potency rate without compromising complete tumor control.
Highlights
Prostate cancer (PCa) is the second most frequently diagnosed cancer in men worldwide[1]
The controversial viewpoint deemed that the intrafascial technique might result in an incomplete resection and increased the rate of positive surgical margin (PSM), which correlated with the biochemical free survival (BFS) rate closely[13,14,15]
Several studies comparing intrafascial radical prostatectomy (IFRP) and non-intrafascial radical prostatectomy (NIFRP) for low risk localized prostate cancer (PCa) have been reported in various medical centers from different countries[16,17,18,19,20,21,22], but the oncological and functional results differed
Summary
Prostate cancer (PCa) is the second most frequently diagnosed cancer in men worldwide[1]. Walsh distinguished the locations of neurovascular bundles (NVBs) in relation to the fascial planes around the prostate, and the modified surgical techniques became possible to preserve the NVBs2–4. The NVBs were not just confined to a single bundle, but consist of variable distribution nerves in ventrolateral and dorsal position of periprostatic fascia[5,6,7,8]. Stolzenburg et al.[9] reported that the intrafascial nerve sparing technique could preserve the nerve fibers surrounding the fascia of the prostate, which played a significant role in the preservation of potency and continence. Improved potency and continence rates after intrafascial nerve sparing prostatectomy have been reported in many studies[10,11,12]. This systematic review and meta-analysis was conducted based on the current available evidences
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