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Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy.
Eur Urol. 2012 Jul; 62(1):1-15.EU

Abstract

CONTEXT

Radical prostatectomy (RP) approaches have rarely been compared adequately with regard to margin and perioperative complication rates.

OBJECTIVE

Review the literature from 2002 to 2010 and compare margin and perioperative complication rates for open retropubic RP (ORP), laparoscopic RP (LRP), and robot-assisted LRP (RALP).

EVIDENCE ACQUISITION

Summary data were abstracted from 400 original research articles representing 167,184 ORP, 57,303 LRP, and 62,389 RALP patients (total: 286,876). Articles were found through PubMed and Scopus searches and met a priori inclusion criteria (eg, surgery after 1990, reporting margin rates and/or perioperative complications, study size>25 cases). The primary outcomes were positive surgical margin (PSM) rates, as well as total intra- and perioperative complication rates. Secondary outcomes included blood loss, transfusions, conversions, length of hospital stay, and rates for specific individual complications. Weighted averages were compared for each outcome using propensity adjustment.

EVIDENCE SYNTHESIS

After propensity adjustment, the LRP group had higher positive surgical margin rates than the RALP group but similar rates to the ORP group. LRP and RALP showed significantly lower blood loss and transfusions, and a shorter length of hospital stay than the ORP group. Total perioperative complication rates were higher for ORP and LRP than for RALP. Total intraoperative complication rates were low for all modalities but lowest for RALP. Rates for readmission, reoperation, nerve, ureteral, and rectal injury, deep vein thrombosis, pneumonia, hematoma, lymphocele, anastomotic leak, fistula, and wound infection showed significant differences between groups, generally favoring RALP. The lack of randomized controlled trials, use of margin status as an indicator of oncologic control, and inability to perform cost comparisons are limitations of this study.

CONCLUSIONS

This meta-analysis demonstrates that RALP is at least equivalent to ORP or LRP in terms of margin rates and suggests that RALP provides certain advantages, especially regarding decreased adverse events.

Authors+Show Affiliations

Institute of Prostate Cancer and LeFrak Center for Robotic Surgery, James Buchanan Brady Foundation Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY 10065, USA. ashtewarimd@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

22405509

Citation

Tewari, Ashutosh, et al. "Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: a Systematic Review and Meta-analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy." European Urology, vol. 62, no. 1, 2012, pp. 1-15.
Tewari A, Sooriakumaran P, Bloch DA, et al. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012;62(1):1-15.
Tewari, A., Sooriakumaran, P., Bloch, D. A., Seshadri-Kreaden, U., Hebert, A. E., & Wiklund, P. (2012). Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. European Urology, 62(1), 1-15. https://doi.org/10.1016/j.eururo.2012.02.029
Tewari A, et al. Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: a Systematic Review and Meta-analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy. Eur Urol. 2012;62(1):1-15. PubMed PMID: 22405509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. AU - Tewari,Ashutosh, AU - Sooriakumaran,Prasanna, AU - Bloch,Daniel A, AU - Seshadri-Kreaden,Usha, AU - Hebert,April E, AU - Wiklund,Peter, Y1 - 2012/02/24/ PY - 2011/12/02/received PY - 2012/02/14/accepted PY - 2012/3/13/entrez PY - 2012/3/13/pubmed PY - 2012/12/12/medline SP - 1 EP - 15 JF - European urology JO - Eur Urol VL - 62 IS - 1 N2 - CONTEXT: Radical prostatectomy (RP) approaches have rarely been compared adequately with regard to margin and perioperative complication rates. OBJECTIVE: Review the literature from 2002 to 2010 and compare margin and perioperative complication rates for open retropubic RP (ORP), laparoscopic RP (LRP), and robot-assisted LRP (RALP). EVIDENCE ACQUISITION: Summary data were abstracted from 400 original research articles representing 167,184 ORP, 57,303 LRP, and 62,389 RALP patients (total: 286,876). Articles were found through PubMed and Scopus searches and met a priori inclusion criteria (eg, surgery after 1990, reporting margin rates and/or perioperative complications, study size>25 cases). The primary outcomes were positive surgical margin (PSM) rates, as well as total intra- and perioperative complication rates. Secondary outcomes included blood loss, transfusions, conversions, length of hospital stay, and rates for specific individual complications. Weighted averages were compared for each outcome using propensity adjustment. EVIDENCE SYNTHESIS: After propensity adjustment, the LRP group had higher positive surgical margin rates than the RALP group but similar rates to the ORP group. LRP and RALP showed significantly lower blood loss and transfusions, and a shorter length of hospital stay than the ORP group. Total perioperative complication rates were higher for ORP and LRP than for RALP. Total intraoperative complication rates were low for all modalities but lowest for RALP. Rates for readmission, reoperation, nerve, ureteral, and rectal injury, deep vein thrombosis, pneumonia, hematoma, lymphocele, anastomotic leak, fistula, and wound infection showed significant differences between groups, generally favoring RALP. The lack of randomized controlled trials, use of margin status as an indicator of oncologic control, and inability to perform cost comparisons are limitations of this study. CONCLUSIONS: This meta-analysis demonstrates that RALP is at least equivalent to ORP or LRP in terms of margin rates and suggests that RALP provides certain advantages, especially regarding decreased adverse events. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/22405509/Positive_surgical_margin_and_perioperative_complication_rates_of_primary_surgical_treatments_for_prostate_cancer:_a_systematic_review_and_meta_analysis_comparing_retropubic_laparoscopic_and_robotic_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(12)00223-0 DB - PRIME DP - Unbound Medicine ER -