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Meta-Analysis
. 2017 Sep 12;9(9):CD009625.
doi: 10.1002/14651858.CD009625.pub2.

Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer

Dragan Ilic  1 , Sue M Evans, Christie Ann Allan, Jae Hung Jung, Declan Murphy, Mark Frydenberg
Affiliations
Meta-Analysis

Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer

Dragan Ilic et al. Cochrane Database Syst Rev. .

Abstract

Background: Prostate cancer is commonly diagnosed in men worldwide. Surgery, in the form of radical prostatectomy, is one of the main forms of treatment for men with localised prostate cancer. Prostatectomy has traditionally been performed as open surgery, typically via a retropubic approach. The advent of laparoscopic approaches, including robotic-assisted, provides a minimally invasive alternative to open radical prostatectomy (ORP).

Objectives: To assess the effects of laparoscopic radical prostatectomy or robotic-assisted radical prostatectomy compared to open radical prostatectomy in men with localised prostate cancer.

Search methods: We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings with no restrictions on the language of publication or publication status, up until 9 June 2017. We also searched bibliographies of included studies and conference proceedings.

Selection criteria: We included all randomised controlled trials (RCTs) with a direct comparison of laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP) to ORP, including pseudo-RCTs.

Data collection and analysis: Two review authors independently classified studies and abstracted data. The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions. We performed statistical analyses using a random-effects model and assessed the quality of the evidence according to GRADE.

Main results: We included two unique studies with 446 randomised participants with clinically localised prostate cancer. The mean age, prostate volume, and prostate-specific antigen (PSA) of the participants were 61.3 years, 49.78 mL, and 7.09 ng/mL, respectively. Primary outcomes We found no study that addressed the outcome of prostate cancer-specific survival. Based on data from one trial, RARP likely results in little to no difference in urinary quality of life (MD -1.30, 95% CI -4.65 to 2.05) and sexual quality of life (MD 3.90, 95% CI -1.84 to 9.64). We rated the quality of evidence as moderate for both quality of life outcomes, downgrading for study limitations. Secondary outcomes We found no study that addressed the outcomes of biochemical recurrence-free survival or overall survival.Based on one trial, RARP may result in little to no difference in overall surgical complications (RR 0.41, 95% CI 0.16 to 1.04) or serious postoperative complications (RR 0.16, 95% CI 0.02 to 1.32). We rated the quality of evidence as low for both surgical complications, downgrading for study limitations and imprecision.Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at one day (MD -1.05, 95% CI -1.42 to -0.68 ) and up to one week (MD -0.78, 95% CI -1.40 to -0.17). We rated the quality of evidence for both time-points as low, downgrading for study limitations and imprecision. Based on one study, RARP likely results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI -0.32 to 0.34). We rated the quality of evidence as moderate, downgrading for study limitations.Based on one study, RARP likely reduces the length of hospital stay (MD -1.72, 95% CI -2.19 to -1.25). We rated the quality of evidence as moderate, downgrading for study limitations.Based on two study, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI 0.12 to 0.46). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1000 men (95% CI 78 fewer to 48 fewer). We rated the quality of evidence as low, downgrading for study limitations and indirectness.We were unable to perform any of the prespecified secondary analyses based on the available evidence. All available outcome data were short-term and we were unable to account for surgeon volume or experience.

Authors' conclusions: There is no high-quality evidence to inform the comparative effectiveness of LRP or RARP compared to ORP for oncological outcomes. Urinary and sexual quality of life-related outcomes appear similar.Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions. All available outcome data were short-term, and this study was unable to account for surgeon volume or experience.

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Conflict of interest statement

Dragan Ilic: none declared

Sue Evans: none declared

Christie Allan: none declared

Jae Hung Jung: none declared

Declan Murphy: none declared

Mark Frydenberg: none declared

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 1 Urinary QoL (short term).
1.2
1.2. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 2 Sexual QoL (short term).
1.3
1.3. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 3 Surgical complications (short term).
1.4
1.4. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 4 Serious postoperative complications (short term).
1.5
1.5. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 5 Postoperative pain (at 1 day).
1.6
1.6. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 6 Postoperative pain (at 1 week).
1.7
1.7. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 7 Postoperative pain (at 12 weeks).
1.8
1.8. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 8 Hospital stay (short term ).
1.9
1.9. Analysis
Comparison 1 Laparoscopic radical prostatectomy/ robotic‐assisted radical prostatectomy vs open radical prostatectomy, Outcome 9 Blood transfusion (short term).
See this image and copyright information in PMC

Update of

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Ilic 2012
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