Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis

Abstract

PurposeTo systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer.Materials and MethodsElectronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies.ResultsA total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up.ConclusionRARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP.

Comparison of perioperative outcomes in elderly (age ≧ 75 years) vs. younger men undergoing robot-assisted radical prostatectomy

“…Conversely, not all elderly men are unhealthy and intolerable to surgery. Besides, robot-assisted radical prostatectomy (RARP) has a better safety profile compared to open RP [4][5][6]. For this reason, it may be feasible to expand surgical indications of RARP to older men.…”

Precision surgery and genitourinary cancers

“…Nevertheless, there is still a debate on "robotic versus open surgery" for prostate cancer mainly fueled by large population-based data analyses ( In another large retrospective analysis of administrative data Leow et al looked at outcomes and costs of over 600,000 radical prostatectomies done in the USA over a 10-year period. 52 First of all, they found utilization of robotic surgery rapidly increased from 1 53 They included 61 studies, and confirmed that RARP carries a lower risk of complications and urinary incontinence, as well as higher potency rate, whereas positive margin rates and recurrence free survival were similar. However, the authors pointed out the low quality of available studies.…”

Can anastomotic urinary leakage in robotic prostatectomy be considered as a marker of surgical skill?

“…Over the last 10 years, the introduction of robotic surgery has progressively changed the surgical management of patients with prostate cancer, reducing the invasiveness of radical prostatectomy and improving outcomes [ 1 ]. During the same period, new kinds of sutures, such as those with barbs, and consequently novel surgical techniques, were introduced.…”