Yonsei Med J.  2016 Sep;57(5):1165-1177. 10.3349/ymj.2016.57.5.1165.

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

• Seo HJ
• Lee NR
• Son SK
• Kim DK
• Rha KH
• Lee SH

• KMID: 2374162
• DOI: http://doi.org/10.3349/ymj.2016.57.5.1165

Abstract

PURPOSE
To 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 METHODS
Electronic 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.
RESULTS
A 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.
CONCLUSION
RARP 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.

Keyword

Prostatic neoplasms; robotics; prostatectomy; meta-analysis

MeSH Terms

Humans
Male
Postoperative Complications/*etiology
Prostatectomy/*adverse effects/methods
Prostatic Neoplasms/surgery
Robotic Surgical Procedures/*adverse effects
Treatment Outcome
Urinary Incontinence/etiology

Figure

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  Fig. 1 Study selection flow-diagram

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  Fig. 2 The summary of risk of bias

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  Fig. 3 Functional outcomes: RARP vs. RRP. (A) Incontinence rate at 12 months after surgery. (B) Potency rate at 12 months after surgery. RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy; CI, confidence interval

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  Fig. 4 Positive margin rate: RARP vs. RRP. (A) Positive margin rate. RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy; CI, confidence interval. (B) Positive margin rate of studies assessed as low risk studies. (C) Positive margin rate for pT2 tumors in studies published after 2010. RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy; CI, confidence interval

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  Fig. 5 Biochemical recurrence: RARP vs. RRP. (A) Biochemical recurrence according to definition of PSA failure. RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy; CI, confidence interval. (B) Biochemical recurrence according to follow-up duration. RARP, robot-assisted radical prostatectomy; RRP, retropubic radical prostatectomy; CI, confidence interval.

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