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Meta-Analysis
. 2025 Apr 27:80:100636.
doi: 10.1016/j.clinsp.2025.100636. eCollection 2025.

Minimally invasive radical prostatectomy versus open radical prostatectomy: A systematic review and meta-analysis of randomized control trials

Caio Felipe Araujo Matalani  1 , Mateus Silva Santos Costa  1 , Marcelo Ribeiro da Rocha  1 , Roberto Iglesias Lopes  1 , Thalita Bento Talizin  1 , José Bessa Júnior  2 , William Carlos Nahas  1 , Leopoldo Alves Ribeiro-Filho  1 , Caio Vinicius Suartz  3
Affiliations
Meta-Analysis

Minimally invasive radical prostatectomy versus open radical prostatectomy: A systematic review and meta-analysis of randomized control trials

Caio Felipe Araujo Matalani et al. Clinics (Sao Paulo). .

Abstract

Objective: To evaluate the comparative outcomes of Minimally Invasive Radical Prostatectomy (MIRP) versus Open Radical Prostatectomy (ORP) to treat localized prostate cancer, using only Randomized Controlled Trials (RCTs) to ensure high-quality evidence.

Method: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, focusing solely on RCTs comparing MIRP (robot-assisted or laparoscopic surgery) and ORP. Literature searches across multiple databases, including Cochrane Library, Medline, Embase, Lilacs, Scopus, Web of Science, NIH, Clinical Trials, and EU Clinical Trials Register, identified studies meeting predefined PICOT criteria. Four RCTs met inclusion criteria ‒ two representing the same cohort of patients ‒ and were analyzed for perioperative, functional, and oncologic outcomes. Quality assessment utilized the ROB-2 tool to gauge the risk of bias.

Results: Three RCTs encompassing 1051 patients were analyzed. MIRP demonstrated statistically significant benefits over ORP in terms of reduced perioperative blood loss (Standardized Mean Difference [SMD = -3.058], p = 0.006), lower transfusion rates (Odds Ratio [OR = 0.137]; p = 0.009), and fewer overall complications (OR = 0.465; p = 0001). However, no significant differences were found in long-term oncologic and functional outcomes, including urinary continence and erectile function. Positive surgical margins and additional treatments also did not differ significantly between groups.

Conclusion: This systematic review and meta-analysis of RCTs indicated that MIRP offers perioperative advantages over ORP, supporting its role as a safe and effective option for localized prostate cancer.

Keywords: Meta-Analysis; Open radical prostatectomy; Prostate cancer; Randomized Control Trial; Robot-assisted radical prostatectomy.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
Shows the PRISMA flowchart of the literature search.
Fig 2
Fig. 2
RoB 2.
Fig 3
Fig. 3
(A) Surgical duration; (B) Estimated blood loss; (C) Intraoperative transfusion rate; (D) Overall Complication; (E) Urinary continence at six months; (F) Urinary continence at 12-months; (G) Urinary continence at longest follow-up; (H) Erectile Function at six months; (I) Erectile function at 12-months; (J) Positive surgical margin; (K) Positive surgical margin in pT ≤2; (L) Positive surgical margin in pT3 and above; (M) Additional treatment.
Fig 3
Fig. 3
(A) Surgical duration; (B) Estimated blood loss; (C) Intraoperative transfusion rate; (D) Overall Complication; (E) Urinary continence at six months; (F) Urinary continence at 12-months; (G) Urinary continence at longest follow-up; (H) Erectile Function at six months; (I) Erectile function at 12-months; (J) Positive surgical margin; (K) Positive surgical margin in pT ≤2; (L) Positive surgical margin in pT3 and above; (M) Additional treatment.
Fig 3
Fig. 3
(A) Surgical duration; (B) Estimated blood loss; (C) Intraoperative transfusion rate; (D) Overall Complication; (E) Urinary continence at six months; (F) Urinary continence at 12-months; (G) Urinary continence at longest follow-up; (H) Erectile Function at six months; (I) Erectile function at 12-months; (J) Positive surgical margin; (K) Positive surgical margin in pT ≤2; (L) Positive surgical margin in pT3 and above; (M) Additional treatment.
See this image and copyright information in PMC

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