Investig Clin Urol.  2017 May;58(3):152-163. 10.4111/icu.2017.58.3.152.

Robot-assisted radical prostatectomy has lower biochemical recurrence than laparoscopic radical prostatectomy: Systematic review and meta-analysis

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

• KMID: 2388059
• DOI: http://doi.org/10.4111/icu.2017.58.3.152

Abstract

PURPOSE
To assess the effectiveness and safety of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer.
MATERIALS AND METHODS
Existing systematic reviews were updated to investigate the effectiveness and safety of RARP. Electronic databases, including Ovid MEDLINE, Ovid Embase, the Cochrane Library, KoreaMed, Kmbase, and others, were searched through July 2014. The quality of the selected systematic reviews was assessed by using the revised assessment of multiple systematic reviews (R-Amstar) and the Cochrane Risk of Bias tool. Meta-analysis was performed by using Revman 5.2 (Cochrane Community) and Comprehensive Meta-Analysis 2.0 (CMA; Biostat). Cochrane Q and I2 statistics were used to assess heterogeneity.
RESULTS
Two systematic reviews and 16 additional studies were selected from a search performed of existing systematic reviews. These included 2 randomized controlled clinical trials and 28 nonrandomized comparative studies. The risk of complications, such as injury to organs by the Clavien-Dindo classification, was lower with RARP than with LRP (relative risk [RR], 0.44; 95% confidence interval [CI], 1.23-0.85; p=0.01). The risk of urinary incontinence was lower (RR, 0.43; 95% CI, 0.31-0.60; p<0.000001) and the potency rate was significantly higher with RARP than with LRP (RR, 1.38; 95% CI, 1.11-1.70; I²=78%; p=0.003). Regarding positive surgical margins, no significant difference in risk between the 2 groups was observed; however, the biochemical recurrence rate was lower after RARP than after LRP (RR, 0.59; 95% CI, 0.48-0.73; I²=21%; p<0.00001).
CONCLUSIONS
RARP appears to be a safe and effective technique compared with LRP with a lower complication rate, better potency, a higher continence rate, and a decreased rate of biochemical recurrence.

Keyword

Laparoscopy; Meta-analysis; Prostatic neoplasms; Prostatectomy; Robotics

MeSH Terms

Bias (Epidemiology)
Classification
Laparoscopy
Population Characteristics
Prostatectomy*
Prostatic Neoplasms
Recurrence*
Robotics
Urinary Incontinence

Figure

• 

  Fig. 1 Flow diagram of the study selection process.

• 

  Fig. 2 Cumulative analyses of robot-assisted radical prostatectomy comparing laparoscopic radical prostatectomy in postoperative complication (A: Clavien-dindo classification, B: Organ injury). RARP, robot-assisted radical prostatectomy; LRP, laparoscopic radical prostatectomy; M-H, Mantel Haenszel; CI, confidence interval; df, degrees of freedom.

• 

  Fig. 3 Cumulative analyses of robot-assisted radical prostatectomy comparing laparoscopic radical prostatectomy in functional outcome (A: Urinary incontinence rate, B: Sexual function recovery rate). RARP, robot-assisted radical prostatectomy; LRP, laparoscopic radical prostatectomy; M-H, Mantel-Haenszel; CI, confidence interval; df, degrees of freedom.

• 

  Fig. 4 Cumulative analyses of robot-assisted radical prostatectomy comparing laparoscopic radical prostatectomy in oncologic outcome (A: Positive surgical margin, B: Biochemical recurrence). RARP, robot-assisted radical prostatectomy; LRP, laparoscopic radical prostatectomy; M-H, Mantel-Haenszel; CI, confidence interval; df, degrees of freedom.

• 

  Fig. 5 Funnel plot of the studies of organ injury (A), blood transfusion rate (B), operative time (C), length of stay (D), potency (E) and overall biochemical recurrence (F) used in the meta-analysis.

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