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Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis.
Medicine (Baltimore). 2019 May; 98(22):e15770.M

Abstract

BACKGROUND

To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy (RARP), or laparoscopic radical prostatectomy (LRP) comparing with open radical prostatectomy (ORP) in men with clinically localized prostate cancer through all prospective comparative studies.

METHODS

A comprehensive literature search was performed in August 2018 using the Pubmed, Medline, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) and prospective studies including patients with clinically localized prostate cancer were eligible for study inclusion. Cumulative analysis was conducted using Review Manager v. 5.3 software.

RESULTS

Two RCTs and 9 prospective studies were included in this systematic review. There were no significant differences between RARP/LRP and ORP in overall complication rate, major complication rate, overall positive surgical margin (PSM) rate, ≤pT2 tumor PSM rate, ≥pT3 tumor PSM rate. Moreover, RARP/LRP and ORP showed similarity in biochemical recurrence (BCR) rate at 3, 12, 24 months postoperatively. Urinary continence and erectile function at 12 months postoperatively between RARP and ORP are also comparable. RARP/LRP were associated with significantly lower estimated blood loss [mean difference (MD) -749.67, 95% CI -1038.52 to -460.82, P = .001], lower transfusion rate (OR 0.17, 95% CI 0.10 to 0.30, P < .001) and less hospitalization duration (MD -1.18, 95% CI -2.18 to -0.19, P = .02). And RARP/LRP required more operative time (MD 50.02, 95% CI 6.50 to 93.55, P = .02) and cost.

CONCLUSION

RARP/LRP is associated with lower blood loss, transfusion rate and less hospitalization duration. The available data were insufficient to prove the superiority of any surgical approach in terms of postoperative complications, functional and oncologic outcomes.

Authors+Show Affiliations

Xiangya School of Medicine.Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31145297

Citation

Cao, Lan, et al. "Robot-assisted and Laparoscopic Vs Open Radical Prostatectomy in Clinically Localized Prostate Cancer: Perioperative, Functional, and Oncological Outcomes: a Systematic Review and Meta-analysis." Medicine, vol. 98, no. 22, 2019, pp. e15770.
Cao L, Yang Z, Qi L, et al. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore). 2019;98(22):e15770.
Cao, L., Yang, Z., Qi, L., & Chen, M. (2019). Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine, 98(22), e15770. https://doi.org/10.1097/MD.0000000000015770
Cao L, et al. Robot-assisted and Laparoscopic Vs Open Radical Prostatectomy in Clinically Localized Prostate Cancer: Perioperative, Functional, and Oncological Outcomes: a Systematic Review and Meta-analysis. Medicine (Baltimore). 2019;98(22):e15770. PubMed PMID: 31145297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. AU - Cao,Lan, AU - Yang,Zhenyu, AU - Qi,Lin, AU - Chen,Minfeng, PY - 2019/5/31/entrez PY - 2019/5/31/pubmed PY - 2019/6/14/medline SP - e15770 EP - e15770 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 22 N2 - BACKGROUND: To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy (RARP), or laparoscopic radical prostatectomy (LRP) comparing with open radical prostatectomy (ORP) in men with clinically localized prostate cancer through all prospective comparative studies. METHODS: A comprehensive literature search was performed in August 2018 using the Pubmed, Medline, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) and prospective studies including patients with clinically localized prostate cancer were eligible for study inclusion. Cumulative analysis was conducted using Review Manager v. 5.3 software. RESULTS: Two RCTs and 9 prospective studies were included in this systematic review. There were no significant differences between RARP/LRP and ORP in overall complication rate, major complication rate, overall positive surgical margin (PSM) rate, ≤pT2 tumor PSM rate, ≥pT3 tumor PSM rate. Moreover, RARP/LRP and ORP showed similarity in biochemical recurrence (BCR) rate at 3, 12, 24 months postoperatively. Urinary continence and erectile function at 12 months postoperatively between RARP and ORP are also comparable. RARP/LRP were associated with significantly lower estimated blood loss [mean difference (MD) -749.67, 95% CI -1038.52 to -460.82, P = .001], lower transfusion rate (OR 0.17, 95% CI 0.10 to 0.30, P < .001) and less hospitalization duration (MD -1.18, 95% CI -2.18 to -0.19, P = .02). And RARP/LRP required more operative time (MD 50.02, 95% CI 6.50 to 93.55, P = .02) and cost. CONCLUSION: RARP/LRP is associated with lower blood loss, transfusion rate and less hospitalization duration. The available data were insufficient to prove the superiority of any surgical approach in terms of postoperative complications, functional and oncologic outcomes. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/31145297/Robot_assisted_and_laparoscopic_vs_open_radical_prostatectomy_in_clinically_localized_prostate_cancer:_perioperative_functional_and_oncological_outcomes:_A_Systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1097/MD.0000000000015770 DB - PRIME DP - Unbound Medicine ER -