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Meta-Analysis
. 2021 Oct;39(10):3721-3732.
doi: 10.1007/s00345-021-03687-5. Epub 2021 Apr 11.

Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes

Umberto Carbonara #  1   2 , Maya Srinath #  1 , Fabio Crocerossa  1   3 , Matteo Ferro  4 , Francesco Cantiello  3 , Giuseppe Lucarelli  2 , Francesco Porpiglia  5 , Michele Battaglia  2 , Pasquale Ditonno  2   6 , Riccardo Autorino  7
Affiliations
Meta-Analysis

Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes

Umberto Carbonara et al. World J Urol. 2021 Oct.

Abstract

Purpose: To provide a systematic analysis of the comparative outcomes of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer based on the best currently available evidence.

Methods: An independent systematic review of the literature was performed up to February 2021, using MEDLINE®, EMBASE®, and Web of Science® databases. Preferred reporting items for systematic review and meta-analysis (PRISMA) recommendations were followed to design search strategies, selection criteria, and evidence reports. The quality of the included studies was determined using the Newcastle-Ottawa scale for non-randomized controlled trials. Demographics and clinical characteristics, surgical, pathological, and functional outcomes were collected.

Results: Twenty-six studies were identified. Only 16 "high-quality" (RCTs and Newcastle-Ottawa scale 8-9) studies were included in the meta-analysis. Among the 13,752 patients included, 6135 (44.6%) and 7617 (55.4%) were RARP and LRP, respectively. There was no difference between groups in terms of demographics and clinical characteristics. Overall and major complication (Clavien-Dindo ≥ III) rates were similar in LRP than RARP group. The biochemical recurrence (BCR) rate at 12months was significantly lower for RARP (OR: 0.52; 95% CI 0.43-0.63; p < 0.00001). RARP reported lower urinary incontinence rate at 12months (OR: 0.38; 95% CI 0.18-0.8; p = 0.01). The erectile function recovery rate at 12months was higher for RARP (OR: 2.16; 95% CI 1.23-3.78; p = 0.007).

Conclusion: Current evidence shows that RARP offers favorable outcomes compared with LRP, including higher potency and continence rates, and less likelihood of BCR. An assessment of longer-term outcomes is lacking, and higher cost remains a concern of robotic versus laparoscopic prostate cancer surgery.

Keywords: Laparoscopic radical prostatectomy; Meta-analysis; Prostatic cancer; Robotic radical prostatectomy.

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References

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