Robot‐assisted radical prostatectomy compared with open and laparoscopic approaches: A systematic review and meta‐analysis

Abstract

Abbreviations & AcronymsAbstract: Medline and Embase were searched for studies comparing robot-assisted radical prostatectomy with open prostatectomy and conventional laparoscopic prostatectomy. Random effects meta-analysis was used to calculate a pooled estimate of effect. The 95% prediction intervals are also reported. One randomized study and 50 observational studies were identified. The results show that compared with open surgery, robot-assisted surgery is associated with fewer positive surgical margins for pT2 tumors (relative risk 0.63, 95% confidence interval 0.49-0.81, P < 0.001) and improved outcomes for sexual function at 12 months (relative risk 1.60, 95% confidence interval 1.33-1.93, P = <0.001), and, to a lesser extent, urinary function at 12 months (relative risk 1.06, 95% confidence interval 1.02-1.11, P < 0.01). Compared with conventional laparoscopic prostatectomy, robot-assisted surgery is associated with a slight increase in urinary function at 12 months (relative risk 1.09, 95% confidence interval 1.02 to 1.17, P = 0.013). The overall methodological quality of the included studies was low, with high levels of heterogeneity. The use of prediction intervals as an aid to decision making in regard to the introduction of this technology is examined. Clinically significant improvements in positive surgical margins rates for pT2 tumors and sexual function at 12 months associated with robot-assisted surgery in comparison with open surgery should be interpreted with caution given the limitations of the evidence. Differences between robot-assisted and conventional laparoscopic surgery are minimal.

Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

“…Also estimated blood loss and transfusion rates are reduced. [13][14][15] The patients with localized PCa and a life expectancy of >10 years are usually considered to benefit from RP.…”

Relationship of Positive Resection Margin, Cancer Location and Learning Curve after Laparoscopic Radical Prostatectomy

“…LRP has been discussed in comparison with RRP, but recently LRP has been compared with RARP [13,22]. The oncological outcome was same in many reports, including the two past randomized control trials (RCTs) [23,24].…”

Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy: a prospective assessment of patient scar satisfaction

“…The short length of follow-up and the lack of quality of life assessment can also be regarded as major limitations. More robust analysis has been already performed by others about surgical, functional and oncological outcomes for different radical prostatectomy approaches [9,10,25]. The lack of a quality of life assessment does not allow determining how the cosmetic result impact this in oncological patients.…”

“…Despite the large number of studies comparing oncological and functional outcomes between the different surgical approaches [9,10], available literature on objective scar assessment of patients undergoing RP remains anecdotal [11].…”