Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series
<i>Background and Objectives</i>: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prost...
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2025-01-01
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| author | Do Kyung Kim Young Joon Moon Doo Yong Chung Hae Do Jung Seung Hyun Jeon Seok Ho Kang Sunghyun Paick Joo Yong Lee |
| author_facet | Do Kyung Kim Young Joon Moon Doo Yong Chung Hae Do Jung Seung Hyun Jeon Seok Ho Kang Sunghyun Paick Joo Yong Lee |
| author_sort | Do Kyung Kim |
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| description | <i>Background and Objectives</i>: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. <i>Materials and Methods:</i> A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). <i>Results</i>: A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587–0.869) and LRP (RR 0.672, 95% CrI 0.505–0.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807–0.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997–1.124; RR 0.921, 95% CrI 0.845–1.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047–1.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047–1.402) and LRP (RR 1.438, 95% CrI 1.191–1.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. <i>Conclusions</i>: RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications). |
| format | Article |
| id | doaj-art-0789f65f7ae04db4894ef1cf99bbd58d |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-0789f65f7ae04db4894ef1cf99bbd58d2025-01-24T13:40:25ZengMDPI AGMedicina1010-660X1648-91442025-01-016116110.3390/medicina61010061Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update SeriesDo Kyung Kim0Young Joon Moon1Doo Yong Chung2Hae Do Jung3Seung Hyun Jeon4Seok Ho Kang5Sunghyun Paick6Joo Yong Lee7Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of KoreaDepartment of Urology, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of KoreaDepartment of Urology, Inha University School of Medicine, Incheon 22332, Republic of KoreaDepartment of Urology, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Ilsan 10380, Republic of KoreaDepartment of Urology, Kyung Hee University School of Medicine, Seoul 02447, Republic of KoreaDepartment of Urology, Korea University College of Medicine, Seoul 02841, Republic of KoreaDepartment of Urology, Konkuk University School of Medicine, Seoul 05030, Republic of KoreaDepartment of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea<i>Background and Objectives</i>: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. <i>Materials and Methods:</i> A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). <i>Results</i>: A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587–0.869) and LRP (RR 0.672, 95% CrI 0.505–0.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807–0.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997–1.124; RR 0.921, 95% CrI 0.845–1.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047–1.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047–1.402) and LRP (RR 1.438, 95% CrI 1.191–1.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. <i>Conclusions</i>: RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications).https://www.mdpi.com/1648-9144/61/1/61prostatic neoplasmsprostatectomyroboticslaparoscopynetwork meta-analysis |
| spellingShingle | Do Kyung Kim Young Joon Moon Doo Yong Chung Hae Do Jung Seung Hyun Jeon Seok Ho Kang Sunghyun Paick Joo Yong Lee Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series Medicina prostatic neoplasms prostatectomy robotics laparoscopy network meta-analysis |
| title | Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series |
| title_full | Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series |
| title_fullStr | Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series |
| title_full_unstemmed | Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series |
| title_short | Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series |
| title_sort | comparison of robot assisted laparoscopic and open radical prostatectomy outcomes a systematic review and network meta analysis from kser update series |
| topic | prostatic neoplasms prostatectomy robotics laparoscopy network meta-analysis |
| url | https://www.mdpi.com/1648-9144/61/1/61 |
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