Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?

Purpose This study is a systematic analysis of the evidence regarding oncological, perioperative and postoperative outcomes and the cost of open retropubic radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP). Methods Su...

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Bibliographic Details
Published in:World journal of urology 2018-04, Vol.36 (4), p.609-621
Main Authors: Basiri, Abbas, de la Rosette, Jean JMCH, Tabatabaei, Shahin, Woo, Henry H., Laguna, M. Pilar, Shemshaki, Hamidreza
Format: Article
Language:English
Subjects:
Blood transfusion
Cancer surgery
Comparative Effectiveness Research
Erectile dysfunction
Humans
Laparoscopy
Laparoscopy - adverse effects
Laparoscopy - economics
Laparoscopy - methods
Male
Medicine
Medicine & Public Health
Nephrology
Oncology
Outcome and Process Assessment, Health Care - methods
Prostate cancer
Prostatectomy
Prostatectomy - adverse effects
Prostatectomy - economics
Prostatectomy - methods
Prostatic Neoplasms - surgery
Review
Robotic surgery
Robotic Surgical Procedures - adverse effects
Robotic Surgical Procedures - economics
Robotic Surgical Procedures - methods
Urological surgery
Urology
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Summary:Purpose This study is a systematic analysis of the evidence regarding oncological, perioperative and postoperative outcomes and the cost of open retropubic radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP). Methods Summary data was abstracted from 104 original research articles representing 227,400 patients. PubMed/Medline, Scopus, Google Scholar, EMBASE and the Cochrane Library were reviewed in December 2016. A total of 104 publications were selected for inclusion. The primary outcomes were positive surgical margin (PSM) and major complication rate according to Clavien classifications. Secondary outcomes were operative time, length of hospital stay, estimated blood loss, transfusions, conversions, rate of post-operative erectile dysfunction and incontinence and total cost of procedure. Results ORP had a significantly higher rate than RALP for PSM (OR: 1.18; 95% CI 1.05–1.32; p  = 0.004), but the rate of PSM was not significantly different between ORP versus LRP (OR: 1.37; 95% CI 0.88–2.14; p  = 0.17) and RALP versus LRP (OR: 0.83; 95% CI 0.40–1.72; p  = 0.62). The major Clavien complication rate was significantly different between ORP and RALP (OR: 2.14; 95% CI 1.24–3.68; p  = 0.006). Estimated blood loss, transfusions and length of hospital stay were low for RALP, moderate for LRP and high for ORP. The rate of erectile dysfunction (OR: 2.58; 95% CI 1.77–3.75; p  
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-018-2174-1