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Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis.
Surg Endosc. 2017 03; 31(3):1045-1060.SE

Abstract

BACKGROUND

Robotic surgery has been developed with an attempt to reduce the difficulty of complex laparoscopic procedures. The goal of this study was to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP) through all relevant comparative studies.

METHODS

A literature search of EMBASE, MEDLINE, PubMed, and Cochrane Library databases was conducted. We selected randomized controlled trials (RCTs) and non-randomized comparative studies (including prospective and retrospective studies) comparing perioperative, functional, or oncologic outcomes of both LRP and RARP, and meta-analysis was applied using the Review Manager V5.3 software.

RESULTS

Twenty-four studies were identified in the literature search, including 2 RCTs, 7 prospective studies, and 15 retrospective studies. LRP and RARP showed similarity in the operative time, catheterization duration, in-hospital stay, and overall complication rate. However, blood loss [mean difference (MD) 75.94; p = 0.03] and transfusion rate [odds ratio (OR) 2.08; p = 0.001] were lower in RARP. Moreover, RARP was associated with significantly improved outcomes for continence and potency rates to those of LRP at 3, 6, and 12 months postoperatively. Overall positive surgical margin (PSM) rate (OR 0.88; p = 0.03) was lower in LRP. However, there was no significant differences in ≤pT2 (OR 0.94; p = 0.69) and ≥pT3 (OR 0.94; p = 0.73) PSM rates between LRP and RARP. Additionally, LRP and RARP owned similar biochemical recurrence (BCR) rate (OR 1.15; p = 0.90).

CONCLUSIONS

RARP was associated with lower blood loss and transfusion rate and much greater functional outcomes in contrast to LRP. However, there was no conclusive evidence that RARP was advantaged in terms of perioperative (except for blood loss and transfusion rate) and oncologic outcomes.

Authors+Show Affiliations

Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China.Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China.Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China.Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China. wangxinghuantwo@126.com.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

27444830

Citation

Huang, Xing, et al. "Comparison of Perioperative, Functional, and Oncologic Outcomes Between Standard Laparoscopic and Robotic-assisted Radical Prostatectomy: a Systemic Review and Meta-analysis." Surgical Endoscopy, vol. 31, no. 3, 2017, pp. 1045-1060.
Huang X, Wang L, Zheng X, et al. Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc. 2017;31(3):1045-1060.
Huang, X., Wang, L., Zheng, X., & Wang, X. (2017). Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surgical Endoscopy, 31(3), 1045-1060. https://doi.org/10.1007/s00464-016-5125-1
Huang X, et al. Comparison of Perioperative, Functional, and Oncologic Outcomes Between Standard Laparoscopic and Robotic-assisted Radical Prostatectomy: a Systemic Review and Meta-analysis. Surg Endosc. 2017;31(3):1045-1060. PubMed PMID: 27444830.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. AU - Huang,Xing, AU - Wang,Lei, AU - Zheng,Xinmin, AU - Wang,Xinghuan, Y1 - 2016/07/21/ PY - 2016/05/22/received PY - 2016/07/13/accepted PY - 2016/7/23/pubmed PY - 2017/8/24/medline PY - 2016/7/23/entrez KW - Laparoscopy KW - Meta-analysis KW - Prostate cancer KW - Radical prostatectomy KW - Robotics SP - 1045 EP - 1060 JF - Surgical endoscopy JO - Surg Endosc VL - 31 IS - 3 N2 - BACKGROUND: Robotic surgery has been developed with an attempt to reduce the difficulty of complex laparoscopic procedures. The goal of this study was to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP) through all relevant comparative studies. METHODS: A literature search of EMBASE, MEDLINE, PubMed, and Cochrane Library databases was conducted. We selected randomized controlled trials (RCTs) and non-randomized comparative studies (including prospective and retrospective studies) comparing perioperative, functional, or oncologic outcomes of both LRP and RARP, and meta-analysis was applied using the Review Manager V5.3 software. RESULTS: Twenty-four studies were identified in the literature search, including 2 RCTs, 7 prospective studies, and 15 retrospective studies. LRP and RARP showed similarity in the operative time, catheterization duration, in-hospital stay, and overall complication rate. However, blood loss [mean difference (MD) 75.94; p = 0.03] and transfusion rate [odds ratio (OR) 2.08; p = 0.001] were lower in RARP. Moreover, RARP was associated with significantly improved outcomes for continence and potency rates to those of LRP at 3, 6, and 12 months postoperatively. Overall positive surgical margin (PSM) rate (OR 0.88; p = 0.03) was lower in LRP. However, there was no significant differences in ≤pT2 (OR 0.94; p = 0.69) and ≥pT3 (OR 0.94; p = 0.73) PSM rates between LRP and RARP. Additionally, LRP and RARP owned similar biochemical recurrence (BCR) rate (OR 1.15; p = 0.90). CONCLUSIONS: RARP was associated with lower blood loss and transfusion rate and much greater functional outcomes in contrast to LRP. However, there was no conclusive evidence that RARP was advantaged in terms of perioperative (except for blood loss and transfusion rate) and oncologic outcomes. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/27444830/Comparison_of_perioperative_functional_and_oncologic_outcomes_between_standard_laparoscopic_and_robotic_assisted_radical_prostatectomy:_a_systemic_review_and_meta_analysis_ L2 - https://dx.doi.org/10.1007/s00464-016-5125-1 DB - PRIME DP - Unbound Medicine ER -