To evaluate current views on comparing delayed ligature of the dorsal venous complex (D-DVC) with standard ligature of the dorsal venous complex (S-DVC) for safety, urinary control and oncological outcomes during laparoscopic radical prostatectomy.
A comprehensive searching of PubMed, Web of science, Embase and the Cochrane Library was made and then we performed a meta-analysis, including all randomized controlled trials (RCTs) and retrospective studies, to evaluate the two different techniques.
Two RCTs and six retrospective studies containing 1822 cases (222 cases from RCTs and 1600 cases from retrospective studies) were identified. Although D-DVC was related to more blood loss (WMD: 7.30 mL; 95% CI, 2.43 to 12.16; p = 0.003), the blood transfusion rate between the two groups showed no significant difference (OR = 1.93; 95% CI, 0.55 to 6.73; p = 0.31), and patients in the D-DVC group could benefit from a shorter operative time (WMD: -30.83 min; 95% CI, -53.32 to -8.35; p = 0.007). Positive apical margin events were significantly less in the D-DVC group (OR = 0.39; 95% CI, 0.22 to 0.71; p = 0.002). As for urinary control, there were no differences in continence rates after 3 months (OR = 1.64; 95% CI, 0.98 to 2.73; p = 0.06) and 12 months (OR = 1.00; 95% CI, 0.63 to 1.57; p = 0.99) of follow-up. However, there was a significantly higher continence rate after 6 months of follow-up in the D-DVC group (OR = 1.46; 95% CI, 1.02 to 2.11; p = 0.04).
Standard and delayed approaches to DVC are equally safe and result in similar urinary control. The delayed approach could decrease the positive apical margin rate. However, further large-scale prospective studies are needed to investigate and compare the prognosis and long-term functional outcomes between the two approaches.
International journal of surgery (London, England). 2019 Jul 02 [Epub ahead of print]
Huihuang Li, Jinbo Chen, Yu Cui, Peihua Liu, Zhenglin Yi, Xiongbing Zu
Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: ., Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: ., Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: ., Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: ., Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: ., Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. Electronic address: .