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Review
. 2018 Jan 14:24:272-287.
doi: 10.12659/msm.907092.

Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis

Yuefeng Du  1 , Qingzhi Long  2 , Bin Guan  2 , Lijun Mu  1 , Juanhua Tian  1 , Yumei Jiang  1 , Xiaojing Bai  1 , Dapeng Wu  1
Affiliations
Review

Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis

Yuefeng Du et al. Med Sci Monit. .

Abstract

BACKGROUND Robot-assisted radical prostatectomy (RARP) is increasingly used worldwide, but comparisons of perioperative, functional, and oncologic outcomes among RARP, laparoscopic radical prostatectomy (LRP), and open radical prostatectomy (ORP) remain inconsistent. MATERIAL AND METHODS Systematic literature searches were conducted using EMBASE, PubMed, the Cochrane Library, CNKI, and Science Direct/Elsevier up to April 2017. A meta-analysis was conducted using Review Manager and Stata software. RESULTS We included 33 studies. Meta-analysis revealed that blood loss, transfusion rate, and positive surgical margin (PSM) rate were significantly lower following RARP compared with LRP (SMD (95% confidence interval [CI]) 0.31 [0.01, 0.61]; combined ORs (95% CI) 5.32 [1.29, 21.98]; 1.27 [1.10, 1.46]) and ORP (SMD (95% CI) 0.75 [0.30, 1.21]; and combined ORs (95% CI) 3.44 [1.21, 9.79]); positive surgical margin (PSM) rates were significantly lower following RARP compared with LRP (combined ORs (95% CI) 1.27 [1.10, 1.46]), but not ORP. Operation time was also shorter for RARP than for LRP. The rates of nerve-sparing, recovery of complete urinary continence, and recovery of erectile function were significantly higher following RARP compared with LRP (combined ORs (95% CI) 0.55 [0.31, 0.95]; 0.66 [0.55, 0.78]; 0.46 [0.30, 0.71]) and ORP (combined ORs (95% CI) 0.36 [0.21, 0.63]; 0.33 [0.15, 0.74]; 0.65 [0.37, 1.14]). CONCLUSIONS This meta-analysis demonstrates that RARP results in better overall outcomes than LRP and ORP in terms of blood loss, transfusion rate, nerve sparing, urinary continence and erectile dysfunction recovery, and suggests that RARP offers better results than LRP and ORP in treatment of prostate cancer. However, studies with larger sample sizes and long-term results are needed.

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Conflict of interest statement

Conflict of interests

None.

Figures

Figure 1
Figure 1
Flow diagram of selection of eligible studies.
Figure 2
Figure 2
Forest plot showing the meta-analysis outcomes of the comparisons of blood loss after ORP, LRP and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 3
Figure 3
Forest plot showing the meta-analysis outcomes of the comparisons of transfusion rate after ORP, LRP, and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 4
Figure 4
Forest plot showing the meta-analysis outcomes of the comparisons of PSM after ORP, LRP and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 5
Figure 5
Forest plot showing the meta-analysis outcomes of the comparisons of operate time after ORP, LRP and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 6
Figure 6
Forest plot showing the meta-analysis outcomes of the comparisons of nerve sparing rate after ORP, LRP and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 7
Figure 7
Forest plot showing the meta-analysis outcomes of the comparisons of urinary continence after ORP, LRP and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 8
Figure 8
Forest plot showing the meta-analysis outcomes of the comparisons of erectile function after ORP, LRP and RARP, (A) ORP vs. RARP; (B) LRP vs. RARP; (C) ORP vs. LRP.
Figure 9
Figure 9
Begg’s publication bias plot of operate time.
Figure 10
Figure 10
Begg’s publication bias plot of blood loss.
Figure 11
Figure 11
Begg’s publication bias plot of transfusion rate.
Figure 12
Figure 12
Begg’s publication bias plot of PSM.
Figure 13
Figure 13
Begg’s publication bias plot of nerve sparing.
Figure 14
Figure 14
Begg’s publication bias plot of urinary continence.
Figure 15
Figure 15
Begg’s publication bias plot of erectile function.
See this image and copyright information in PMC

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