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Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?

Abstract

Purpose

This study is a systematic analysis of the evidence regarding oncological, perioperative and postoperative outcomes and the cost of open retropubic radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP).

Methods

Summary data was abstracted from 104 original research articles representing 227,400 patients. PubMed/Medline, Scopus, Google Scholar, EMBASE and the Cochrane Library were reviewed in December 2016. A total of 104 publications were selected for inclusion. The primary outcomes were positive surgical margin (PSM) and major complication rate according to Clavien classifications. Secondary outcomes were operative time, length of hospital stay, estimated blood loss, transfusions, conversions, rate of post-operative erectile dysfunction and incontinence and total cost of procedure.

Results

ORP had a significantly higher rate than RALP for PSM (OR: 1.18; 95% CI 1.05–1.32; p = 0.004), but the rate of PSM was not significantly different between ORP versus LRP (OR: 1.37; 95% CI 0.88–2.14; p = 0.17) and RALP versus LRP (OR: 0.83; 95% CI 0.40–1.72; p = 0.62). The major Clavien complication rate was significantly different between ORP and RALP (OR: 2.14; 95% CI 1.24–3.68; p = 0.006). Estimated blood loss, transfusions and length of hospital stay were low for RALP, moderate for LRP and high for ORP. The rate of erectile dysfunction (OR: 2.58; 95% CI 1.77–3.75; p < 0.001) and incontinence (OR: 3.57; 95% CI 2.28–5.58; p < 0.001) were significantly lower after RALP than LRP and equivalent for other comparisons. Total cost was highest for RALP, followed by LRP and ORP.

Conclusions

For PSM and peri- and post-operative complications, RALP showed better results than ORP and LRP. In the context of the biases between the studies, one should interpret the results with caution.

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Authors

Contributions

AB: Protocol/project development; data collection or management. JJR: protocol/project development; data collection or management. ST: protocol/project development; data collection or management, manuscript writing/editing. HHW: manuscript writing/editing, data analysis. MPL: manuscript writing/editing, data analysis. HS: protocol/project development; data collection or management, manuscript writing/editing.

Corresponding author

Correspondence to Hamidreza Shemshaki.

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Conflict of interest

No conflict of interest existed.

Research involving human participants and/or animals

The data was gathered as systematic review and no human/animal was involved.

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The data was gathered as systematic review and no human/animal was involved.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Supplementary material 2 (DOCX 59 kb)

Distribution of included studies over time (JPEG 81 kb)

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Forest plot of included studies which comparing major complication rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 24 kb)

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Forest plot of included studies which comparing operative time in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 43 kb)

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Forest plot of included studies which comparing length of hospital stay in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 39 kb)

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Forest plot of included studies which comparing estimated blood loss in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 37 kb)

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Forest plot of included studies which comparing transfusion rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 43 kb)

345_2018_2174_MOESM9_ESM.png

Forest plot of included studies which comparing erectile dysfunction rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 20 kb)

345_2018_2174_MOESM10_ESM.png

Forest plot of included studies which comparing incontinency rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 22 kb)

345_2018_2174_MOESM11_ESM.png

Forest plot of included studies which comparing total cost in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 16 kb)

Difference of stage by stage prostate cancer among the studies (PNG 171 kb)

Supplementary material 13 (DOCX 19 kb)

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Basiri, A., de la Rosette, J.J., Tabatabaei, S. et al. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?. World J Urol 36, 609–621 (2018). https://doi.org/10.1007/s00345-018-2174-1

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Keywords

  • Robotics
  • Laparoscopy
  • Retropubic
  • Prostatectomy
  • Complications
  • Prostate cancer
  • Margins