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

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A Letter to the Editor to this article was published on 14 February 2022

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.

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Author notes

  1. Umberto Carbonara and Maya Srinath contributed to the manuscript equally.

Authors and Affiliations

  1. Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA

    Umberto Carbonara, Maya Srinath, Fabio Crocerossa & Riccardo Autorino

  2. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy

    Umberto Carbonara, Giuseppe Lucarelli, Michele Battaglia & Pasquale Ditonno

  3. Department of Urology, Magna Graecia University, Catanzaro, Italy

    Fabio Crocerossa & Francesco Cantiello

  4. Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy

    Matteo Ferro

  5. Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy

    Francesco Porpiglia

  6. Urology Unit, National Cancer Institute IRCCS, “Giovanni Paolo II”, Bari, Italy

    Pasquale Ditonno

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  1. Umberto Carbonara
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Contributions

UC: Project development, Data collection, Data analysis, Manuscript writing/editing. MS: Project development, Data collection. FC: Project development, Data collection. MF: Critical revision of the manuscript. FC: Critical revision of the manuscript. GL: Critical revision of the manuscript. FP: Critical revision of the manuscript. MB: Critical revision of the manuscript. PD: Critical revision of the manuscript. RA: Supervision.

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Correspondence to Riccardo Autorino.

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Carbonara, U., Srinath, M., Crocerossa, F. et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol 39, 3721–3732 (2021). https://doi.org/10.1007/s00345-021-03687-5

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