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Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies

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Abstract

The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: −516.59 mL; 95%CI: −578.31, −454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: −1.59 days; 95%CI: −2.69, −0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.

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The original data supporting this work are included in the published article or its supplementary information files. Further reasonable requests for data can be made to the corresponding author.

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This study received no external funding.

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Authors and Affiliations

  1. Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China

    Junji Wang, Ke Hu, Yu Wang, Yinyu Wu, Erhao Bao, Jiahao Wang, Chunlin Tan & Tielong Tang

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  6. Jiahao Wang
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  7. Chunlin Tan
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  8. Tielong Tang
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Contributions

All authors contributed to this study. Conceptualization and design: JJW and KH; Material preparation, data extraction, and analysis: JJW, YW, YYW, EHB, and CLT; Manuscript writing: JJW, JHW, and KH; Supervision and review: TLT. All authors have read and approved the final manuscript.

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Correspondence to Tielong Tang.

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Figure 1 Risk of bias for RCTs. Supplementary file1 (TIF 352 KB)

11701_2023_1714_MOESM2_ESM.tif

Figure 2 Sensitivity analysis of outcomes: (A) OT, (B) EBL, (C)length of stay, (D) nerve sparing rate, (E) PSM rate, (F) BCR rate, (G) 6-month urinary continence recovery, (H) 1-year urinary continence recovery, (I) 1-year erectile function recovery, (J) major complications, (K) 3-month urinary continence recovery, (L) ≥2-year urinary continence recovery, (M) 3-month erectile function recovery. Supplementary file2 (TIF 1607 KB)

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Figure 3 Funnel plots and egger's tests to assess publication bias: (A) OT, (B) blood transfusion rate, (C) urinary continence recovery, (D) nerve sparing rate, (E) PSM rate, (F) BCR rate, (G) length of hospital stay, (H) erectile function recovery. Supplementary file3 (TIF 820 KB)

Supplementary file4 (DOCX 26 KB)

Supplementary file5 (PDF 617 KB)

Supplementary file6 (DOCX 17 KB)

Supplementary file7 (DOCX 27 KB)

Supplementary file8 (DOCX 26 KB)

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Wang, J., Hu, K., Wang, Y. et al. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robotic Surg 17, 2617–2631 (2023). https://doi.org/10.1007/s11701-023-01714-8

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