Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy

Systematic Review and Meta-analysis of Studies Reporting Oncologic Outcome After Robot-assisted Radical Prostatectomy

Minimally Invasive Radical Prostatectomy

A Comparison of the Incidence and Location of Positive Surgical Margins in Robotic Assisted Laparoscopic Radical Prostatectomy and Open Retropubic Radical Prostatectomy

Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery After Robot-assisted Radical Prostatectomy

Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis of Comparative Studies

Predictors of Positive Surgical Margins After Laparoscopic Robot Assisted Radical Prostatectomy

ContextThe advantages of minimally invasive surgery for radical prostatectomy (RP) have been demonstrated in a number of systematic reviews (SRs). However, the rigorous study selection process for SR means that a lot of information can be excluded, leading to a very specific clinical scenario that is often unrepresentative of real life. Our new reverse SR methodology generates a heterogeneous population database that covers a wide range of clinical scenarios. ObjectiveTo compare perioperative surgical results and complications for open retropubic RP (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in a reverse SR. Evidence acquisitionEight databases were searched for SRs on RRP, LRP, or RARP between 2000 and 2020 (80 SRs). All references used in these SRs were captured for analysis (1724 articles). Perioperative outcomes and complications were compared among the RRP, LRP, and RARP approaches. Evidence synthesisWe identified 559 (32.4%) reports on RRP, 413 (23.9%) on LRP, and 752 (43.7%) on RARP, involving 1 353 485 patients overall. RARP showed a significantly higher annual volume of surgery per surgeon (AVSS) in comparison to RRP and LRP (mean 64.29, 43.26, and 41.47, respectively), a higher percentage of low-risk patients (prostate-specific antigen <10 ng/ml, Gleason <7, stage <cT2), and a lower rate of lymphadenectomy, culminating in a lower complication rate (12.3% for RARP, 16.3% for LRP, 20.2% for RRP). Among all outcomes, only AVSS was significantly correlated with complication rates. An AVSS of 30, 95 and 95 surgeries/yr was required for RARP, LRP, and RRP, respectively, to obtain a complication rate of 12.3% (average for RARP). RARP showed better performance for all perioperative variables studied except for operative time (operative time: 199.8 vs 214.9 vs 169.5 min; estimated blood loss: 228.2 vs 408.0 vs 852.1 ml; blood transfusion rate: 2.8% vs 6.5% vs 19.8%; length of stay: 2.9 vs 5.7 vs 6.1 d; catheter time: 7.8 vs 8.5 vs 11.0 d for RARP vs LRP vs RRP). ConclusionsOur reverse SR involved a wide real-life representative sample and reference values established in the literature and revealed that minimally invasive surgery had the best perioperative and complication results, especially RARP, which was associated with less complex cases, higher annual surgeon volume, and greater performance. Patient summaryWe used a wide sample representative of real-life surgical practice and reference values established in the literature for three techniques for removal of the prostate to guide patients and physicians in deciding the best surgical treatment for prostate cancer according to availability.

LAPAROSCOPIC RADICAL PROSTATECTOMY WITH THE HEILBRONN TECHNIQUE: AN ANALYSIS OF THE FIRST 180 CASES

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. 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. 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 12months 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). 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.

To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes. A total of 869 patients with body mass index ≥ 30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test. Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS. RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.

Risk and Prevention of Acute Urinary Retention After Robotic Prostatectomy

Comprehensive Prospective Comparative Analysis of Outcomes Between Open and Laparoscopic Radical Prostatectomy Conducted in 2003 to 2005

Objective To compare the efficacy and safety of robot assisted laparoscopic radical prostatectomy (RALRP) and retropubic radical prostatectomy (RRP). Methods From May 2004 to September 2013, data from 124 prostate cancer patients were collected. Of them, 41 cases underwent RALRP, and 83 cases underwent RRP. The following clinical data was reviewed and analyzed, including operation time, blood loss, transfusion rate, duration of catheterization, time of postoperative hospital stay, postoperative pathology, continence and biochemical recurrence. Results All the operations were successfully performed, without RALRP converted to open surgery. The mean operation time of the RALRP group and the RRP group was 224 min and 165 min, mean blood loss was 266 ml and 659 ml, the transfusion rates were 20% and 86%, the mean postoperative hospital stay was 16.4 d and 17.9 d, the positive margin rates were 24% and 10%, the differences were significant (P 0.05). The 6–month, 1–year and 2–year biochemical recurrence rates were 8%, 21% and 24% in RALRP group, and 13%, 16%, 31% in RRP group. The 3–month, 6–month, 1–year and 2–year continence rates were 56%, 70%, 80% and 94% in RALRP group, and 55%, 70%, 78% and 79% in RRP group. For biochemical recurrence and continence rates, there was no significant difference between the 2 groups. Conclusions RALRP possesses advantages of less bleeding and faster recovery. In addition, the effect of postoperative oncology and continence is similar to open surgery. Key words: Prostatic neoplasms; Robots; Retropubic; Biochemical recurrence; Continence

Comparing post-radical prostatectomy erectile function rates among different techniques has always been a challenge in urology. This difficulty is due to the heterogeneity of studies, mainly in relation to the type of erectile function classification criteria used. The aim is to apply a new evidence-gathering methodology, called reverse systematic review, to compare erectile function rates among retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy, considering the diversity of classification criteria. A search was carried out in eight databases between 2000 and 2020 through systematic review studies referring to retropubic radical prostatectomy, laparoscopic radical prostatectomy, or robot-assisted radical prostatectomy (80 systematic reviews). All references used in these systematic reviews were captured by referring to 910 papers in a global database called EVIDENCE. A total of 268 studies related to post-prostatectomy erectile function rates were selected for the final analysis, totaling 465 cohorts or reports referring to 131,350 patients. Note that, 119 (25.6%) reports for retropubic radical prostatectomy, 143 (30.7%) reports for laparoscopic radical prostatectomy, and 203 (43.7%) reports for robot-assisted radical prostatectomy were found. Mean overall erectile function rates, respectively for retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy, were: 16%, 12%, and 35% at 1 month, 22%, 26%, and 42% in 3 months; 30%, 44%, and 54% at 6 months, 41%, 55%, and 59% at 12 months, and 58%, 52%, and 67% at more than 18 months. The most used erectile function criterion was Erection Sufficient for Intercourse (74.1%), followed by Sexual Health Inventory for Men>21 (5.5%), and Sexual Health Inventory for Men>16 (3.7%). Erection Sufficient for Intercourse showed the lowest discrepancy in erectile function rates in each period compared to the global average, for each technique, demonstrating less ability to influence the final results, favoring any of the techniques. The reverse systematic review demonstrated that the robot-assisted radical prostatectomy showed higher rates of erectile function recovery at all times analyzed (1->18 months), in relation to the retropubic radical prostatectomy and laparoscopic radical prostatectomy. The Erection Sufficient for Intercourse criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favoring any of the techniques and might be the fairest option for future comparisons.