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Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy.
Eur Urol. 2012 Sep; 62(3):431-52.EU

Abstract

CONTEXT

Perioperative complications are a major surgical outcome for radical prostatectomy (RP).

OBJECTIVE

Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications.

EVIDENCE ACQUISITION

A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK).

EVIDENCE SYNTHESIS

We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p<0.00001) and transfusion rate (odds ratio [OR]: 7.55; p<0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p=0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach.

CONCLUSIONS

RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach.

Authors+Show Affiliations

University of Padua, Padua, Italy. giacomo.novara@unipd.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

22749853

Citation

Novara, Giacomo, et al. "Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy." European Urology, vol. 62, no. 3, 2012, pp. 431-52.
Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):431-52.
Novara, G., Ficarra, V., Rosen, R. C., Artibani, W., Costello, A., Eastham, J. A., Graefen, M., Guazzoni, G., Shariat, S. F., Stolzenburg, J. U., Van Poppel, H., Zattoni, F., Montorsi, F., Mottrie, A., & Wilson, T. G. (2012). Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. European Urology, 62(3), 431-52. https://doi.org/10.1016/j.eururo.2012.05.044
Novara G, et al. Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy. Eur Urol. 2012;62(3):431-52. PubMed PMID: 22749853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. AU - Novara,Giacomo, AU - Ficarra,Vincenzo, AU - Rosen,Raymond C, AU - Artibani,Walter, AU - Costello,Anthony, AU - Eastham,James A, AU - Graefen,Markus, AU - Guazzoni,Giorgio, AU - Shariat,Shahrokh F, AU - Stolzenburg,Jens-Uwe, AU - Van Poppel,Hendrik, AU - Zattoni,Filiberto, AU - Montorsi,Francesco, AU - Mottrie,Alexandre, AU - Wilson,Timothy G, Y1 - 2012/06/02/ PY - 2012/05/13/received PY - 2012/05/22/accepted PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2013/1/8/medline SP - 431 EP - 52 JF - European urology JO - Eur Urol VL - 62 IS - 3 N2 - CONTEXT: Perioperative complications are a major surgical outcome for radical prostatectomy (RP). OBJECTIVE: Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications. EVIDENCE ACQUISITION: A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK). EVIDENCE SYNTHESIS: We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p<0.00001) and transfusion rate (odds ratio [OR]: 7.55; p<0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p=0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach. CONCLUSIONS: RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/22749853/Systematic_review_and_meta_analysis_of_perioperative_outcomes_and_complications_after_robot_assisted_radical_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(12)00628-8 DB - PRIME DP - Unbound Medicine ER -