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Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis

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Abstract

Open retropubic radical prostatectomy (ORP) remains the “gold standard” for surgical treatment of clinically localized prostate cancer (PCa). Robot-assisted radical prostatectomy (RARP) is a robotic surgery used worldwide. The aim of this study is to collect the data available in the literature on RARP and ORP, and further evaluate the overall safety and efficacy of RARP vs. ORP for the treatment of clinically localized PCa. A literature search was performed using electronic databases between January 2009 and October 2013. Clinical data such as operation duration, transfusion rate, positive surgical margins (PSM), nerve sparing, 3- and 12-month urinary continence, and potency were pooled to carry out meta-analysis. Six studies were enrolled for this meta-analysis. The operation duration of RARP group was longer than that of ORP group (weighted mean difference = 64.84). There was no statistically significant difference in the transfusion rate, PSM rate, and between RARP and ORP (transfusion rate, OR = 0.30; PSM rate, OR = 0.94). No significant difference was seen in 3- and 12-month urinary continence recovery (3 months, OR = 1.32; 12 months, OR = 1.30). There was a statistically significant difference in potency between the 3- and 12-month groups (3 months, OR = 2.80; 12 months, OR = 1.70). RARP is a safe and feasible surgical technique for the treatment of clinically localized PCa owing to the advantages of fewer perioperative complications and quicker patency recovery.

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Abbreviations

PCa:

Prostate cancer

RP:

Radical prostatectomy

ORP:

Open retropubic radical prostatectomy

RRP:

Retropubic radical prostatectomy

RARP:

Robot-assisted radical prostatectomy

RALP:

Robot-assisted laparoscopic prostatectomy

PSA:

Prostate-specific antigen

NOS:

Newcastle–Ottawa Scale

PSM:

Positive surgical margins

OR:

Odds ratio

WMD:

Weighted mean difference

BNC:

Bladder neck contracture

IH:

Inguinal hernia

LC:

Learning curve

References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. Cancer J Clin 63:11–30

    Article  Google Scholar 

  2. Carter HB, Albertsen PC, Barry MJ et al (2013) Early detection of prostate cancer: AUA Guideline. J Urol 190:419–426

    Article  PubMed  PubMed Central  Google Scholar 

  3. Heidenreich A, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part I: screening, diagnosis, and treatment of clinically localised disease. Actas Urol Esp 35:501–514

    CAS  PubMed  Google Scholar 

  4. Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B (2010) Open versus laparoscopic versus robot-assisted laparoscopic prostatectomy: the European and US experience. Rev Urol 12:35–43

    PubMed  PubMed Central  Google Scholar 

  5. Sammon JD, Karakiewicz PI, Sun M et al (2013) Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach. J Urol 189:1289–1294

    Article  PubMed  Google Scholar 

  6. Pasticier G, Rietbergen JB, Guillonneau B, Fromont G, Menon M, Vallancien G (2001) Robotically assisted laparoscopic radical prostatectomy: feasibility study in men. Eur Urol 40:70–74

    Article  CAS  PubMed  Google Scholar 

  7. Yu HY, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Hu JC (2012) Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol 187:1392–1398

    Article  PubMed  Google Scholar 

  8. Piechaud P (2011) State of the art: urologic surgery. J Visc Surg 148:e27–e29

    Article  CAS  PubMed  Google Scholar 

  9. Robertson C, Close A, Fraser C et al (2013) Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: a systematic review and mixed treatment comparison meta-analysis. BJU Int 112:798–812

    Article  PubMed  Google Scholar 

  10. Brandina R, Fau - Berger A, Berger A, Fau-Kimoi K, Fau-Gill IS, Gill IS (2009) Critical appraisal of robotic-assisted radical prostatectomy. Curr Opin Urol 19:290–296

    Article  PubMed  Google Scholar 

  11. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al (2009) The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 19 October 2009

  12. Mantel NHW (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748

    CAS  PubMed  Google Scholar 

  13. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  14. Choo MS, Choi WS, Cho SY, Ku JH, Kim HH, Kwak C (2013) Impact of prostate volume on oncological and functional outcomes after radical prostatectomy: robot-assisted laparoscopic versus open retropubic. Korean J Urol 54:15–21

    Article  PubMed  PubMed Central  Google Scholar 

  15. Di Pierro GB, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A (2011) A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 59:1–6

    Article  PubMed  Google Scholar 

  16. Lo KL, Ng CF, Lam CN, Hou SS, To KF, Yip SK (2010) Short-term outcome of patients with robot-assisted versus open radical prostatectomy: for localised carcinoma of prostate. Hong Kong Med J 16:31–35

    CAS  PubMed  Google Scholar 

  17. Doumerc N, Yuen C, Savdie R et al (2010) Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int 106:378–384

    Article  PubMed  Google Scholar 

  18. Rocco B, Matei DV, Melegari S et al (2009) Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int 104:991–995

    Article  PubMed  Google Scholar 

  19. Krambeck AE, DiMarco DS, Rangel LJ et al (2009) Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 103:448–453

    Article  PubMed  Google Scholar 

  20. Xylinas E, Ploussard G, Durand X, de la Taille A (2013) Robot-assisted extraperitoneal laparoscopic radical prostatectomy: a review of the current literature. Urol Oncol 31:288–293

    Article  PubMed  Google Scholar 

  21. Lim SK, Kim KH, Shin TY, Rha KH (2013) Current status of robot-assisted laparoscopic radical prostatectomy: how does it compare with other surgical approaches? Int J Urol 20:271–284

    Article  PubMed  Google Scholar 

  22. Huang KH, Carter SC, Hu JC (2013) Does robotic prostatectomy meet its promise in the management of prostate cancer? Curr Urol Rep 14:184–191

    Article  PubMed  Google Scholar 

  23. Duffey B, Varda B, Konety B (2011) Quality of evidence to compare outcomes of open and robot-assisted laparoscopic prostatectomy. Curr Urol Rep 12:229–236

    Article  PubMed  Google Scholar 

  24. Trinh QD, Sammon J, Sun M et al (2012) Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 61:679–685

    Article  PubMed  Google Scholar 

  25. Kordan Y, Barocas DA, Altamar HO et al (2010) Comparison of transfusion requirements between open and robotic-assisted laparoscopic radical prostatectomy. BJU Int 106:1036–1040

    Article  PubMed  Google Scholar 

  26. Leyh-Bannurah SR, Hansen J, Isbarn H, et al. (2013) Open and robotic assisted radical retropubic prostatectomy in men with ongoing low-dose aspirin medication: revisiting old paradigm? BJU Int 76:8

  27. Truesdale MD, Polland AR, Graversen JA et al (2011) Impact of HMG-CoA reductase inhibitor (statin) use on blood loss during robot-assisted and open radical prostatectomy. J Endourol 25:1427–1433

    Article  PubMed  Google Scholar 

  28. Evans SM, Millar JL, Frydenberg M et al (2013) Positive surgical margins: rate, contributing factors and impact on further treatment: findings from the Prostate Cancer Registry. BJU Int. doi:10.1111/bju.12509

    PubMed  Google Scholar 

  29. Williams SB, Chen MH, D’Amico AV et al (2010) Radical retropubic prostatectomy and robotic-assisted laparoscopic prostatectomy: likelihood of positive surgical margin(s). Urology 76:1097–1101

    Article  PubMed  Google Scholar 

  30. Silberstein JL, Su D, Glickman L et al (2013) A case-mix-adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons. BJU Int 111:206–212

    Article  PubMed  PubMed Central  Google Scholar 

  31. Punnen S, Meng MV, Cooperberg MR, Greene KL, Cowan JE, Carroll PR (2013) How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int 112:E314–E320

    Article  PubMed  Google Scholar 

  32. Hautmann RE, Sauter TW, Wenderoth UK (1994) Radical retropubic prostatectomy: morbidity and urinary continence in 418 consecutive cases. Urology 43:47–51

    Article  CAS  PubMed  Google Scholar 

  33. Froehner M, Koch R, Leike S, Novotny V, Twelker L, Wirth MP (2013) Urinary tract-related quality of life after radical prostatectomy: open retropubic versus robot-assisted laparoscopic approach. Urol Int 90:36–40

    Article  PubMed  Google Scholar 

  34. Iseki R, Ohori M, Hatano T, Tachibana M (2012) Urinary incontinence in early experience with robot-assisted laparoscopic prostatectomy—comparison with radical retropubic prostatectomy. Hinyokika Kiyo 58:409–414

    PubMed  Google Scholar 

  35. Son SJ, Lee SC, Jeong CW, Jeong SJ, Byun SS, Lee SE (2013) Comparison of continence recovery between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy: a single surgeon experience. Korean J Urol 54:598–602

    Article  PubMed  PubMed Central  Google Scholar 

  36. Breyer BN, Davis CB, Cowan JE, Kane CJ, Carroll PR (2010) Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int 106:1734–1738

    Article  PubMed  PubMed Central  Google Scholar 

  37. Webb DR, Sethi K, Gee K (2009) An analysis of the causes of bladder neck contracture after open and robot-assisted laparoscopic radical prostatectomy. BJU Int 103:957–963

    Article  PubMed  Google Scholar 

  38. Stranne J, Johansson E, Nilsson A et al (2010) Inguinal hernia after radical prostatectomy for prostate cancer: results from a randomized setting and a nonrandomized setting. Eur Urol 58:719–726

    Article  PubMed  Google Scholar 

  39. Abboudi H, Khan MS, Guru KA et al (2013) Learning curves for urological procedures—a systematic review. BJU Int. doi:10.1111/bju.12315

    Google Scholar 

  40. Tomaszewski JJ, Matchett JC, Davies BJ, Jackman SV, Hrebinko RL, Nelson JB (2012) Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy. Urology 80:126–129

    Article  PubMed  Google Scholar 

  41. Kim SP, Shah ND, Karnes RJ et al (2013) Hospitalization costs for radical prostatectomy attributable to robotic surgery. Eur Urol 64:11–16

    Article  PubMed  Google Scholar 

  42. Eldefrawy A, Katkoori D, Abramowitz M, Soloway MS, Manoharan M (2013) Active surveillance vs. treatment for low-risk prostate cancer: a cost comparison. Urol Oncol 31:576–580

    Article  PubMed  Google Scholar 

  43. Kaushik D, High R, Clark CJ, LaGrange CA (2010) Malfunction of the Da Vinci robotic system during robot-assisted laparoscopic prostatectomy: an international survey. J Endourol 24:571–575

    Article  PubMed  Google Scholar 

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Disclosure Statement

No competing financial interests exist.

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Authors and Affiliations

  1. Department of Urologic Surgery, Changzheng Hospital of the Second Military Medical University, Shanghai, 200003, China

    Xiu-wu Pan, Zhi-jun Wang, Fa-jun Qu, Yi Gao, Xin-gang Cui & Dan-feng Xu

  2. Department of EENT & Plastic and Maxillofacial Surgery, Nangang Branch of Heilongjiang Provincial Hospital, No. 405 Guogeli Street, Nangang District, Harbin, 150001, Heilongjiang, China

    Xin-ming Cui

  3. Department of Urologic Surgery, General Hospital of Beijing Military Command, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China

    Jing-fei Teng

  4. Department of Urologic Surgery, First Hospital of Ningbo City, Affiliated Medical School of Ningbo University, Ningbo, 315010, Zhejiang, China

    Dong-xu Zhang

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  1. Xiu-wu Pan
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Correspondence to Xin-gang Cui.

Additional information

Xiu-wu Pan and Xin-ming Cui contributed equally to this work.

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Pan, Xw., Cui, Xm., Teng, Jf. et al. Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis. Indian J Surg 77 (Suppl 3), 1326–1333 (2015). https://doi.org/10.1007/s12262-014-1170-y

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  • DOI: https://doi.org/10.1007/s12262-014-1170-y

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