Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis

Abstract

Open retropubic radical prostatectomy (ORP) remains the "gold standard" for surgical treatment of clinically localized prostate cancer (PCa). Robot-assisted radical prostatectomy (RARP) is a robotic surgery used worldwide. The aim of this study is to collect the data available in the literature on RARP and ORP, and further evaluate the overall safety and efficacy of RARP vs. ORP for the treatment of clinically localized PCa. A literature search was performed using electronic databases between January 2009 and October 2013. Clinical data such as operation duration, transfusion rate, positive surgical margins (PSM), nerve sparing, 3-and 12-month urinary continence, and potency were pooled to carry out metaanalysis. Six studies were enrolled for this meta-analysis. The operation duration of RARP group was longer than that of ORP group (weighted mean difference=64.84). There was no statistically significant difference in the transfusion rate, PSM rate, and between RARP and ORP (transfusion rate, OR=0.30; PSM rate, OR=0.94). No significant difference was seen in 3-and 12-month urinary continence recovery (3 months, OR= 1.32; 12 months, OR=1.30). There was a statistically significant difference in potency between the 3-and 12-month groups (3 months, OR=2.80; 12 months, OR=1.70). RARP is a safe and feasible surgical technique for the treatment of clinically localized PCa owing to the advantages of fewer perioperative complications and quicker patency recovery.Keywords Robot-assisted radical prostatectomy . Open retropubic radical prostatectomy . Prostate cancer Abbreviations PCaProstate cancer RP Radical prostatectomy ORP Open retropubic radical prostatectomy RRP Retropubic radical prostatectomy RARP Robot-assisted radical prostatectomy RALP Robot-assisted laparoscopic prostatectomy PSA Prostate-specific antigen NOS Newcastle-Ottawa Scale Xiu-wu Pan and Xin-ming Cui contributed equally to this work.

The impact of nerve‐sparing robot‐assisted radical prostatectomy on lower urinary tract function: Prospective assessment of patient‐reported outcomes and frequency volume charts

“…Robot‐assisted radical prostatectomy (RARP) is an appropriate surgical technique for the treatment of clinically localized prostate cancer because it offers faster recovery of erectile function than other surgical modalities, such as open and laparoscopic radical prostatectomy . Several recent reports have demonstrated that nerve‐sparing (NS) radical prostatectomy contributes not only to the recovery of erectile function, but also to the improvement of urinary incontinence .…”

A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

“…Figure 1 shows the process of inclusion and exclusion of studies during the systematic literature search. Details on search terms, outcomes of interest, methods for accounting for bias, and so forth are outlined in the figure legend [5,[15][16][17][18][19][20][21][22][23].…”

“…Outcomes of interest included age, transfusions, LOS, individual perioperative complication rates, operative time, PACU time, hernia rates out to 3 years (incisional and inguinal), and continence/incontinence and potency/impotency out to 3 years. Nine systematic reviews were identified [5,[16][17][18][19][20][21][22][23]. The lack of RALP vs. RRP RCTs has resulted in criticisms of comparisons between RALP and RRP due to differences in patient characteristics; patients undergoing RALP tend to be younger and in the earlier stages of the disease, predisposing them to better outcomes.…”

Outcomes of robotic-assisted laparoscopic prostatectomy versus open prostatectomy in surgical intervention of localized prostate cancer

“…We also found several meta-analyses. [8][9][10][11][12][13][14][15][16][17][18] None of these found any difference in mortality or other cancer-related outcomes between RALP and RRP. With regards to the complications of urinary incontinence and sexual dysfunction, results were mixed, with some analyses finding a modest benefit to robotic surgery, and some analyses finding no difference.…”