Dr. Gill summarized the methodology and results of this meta-analysis using summary forest plots, which included data from 181 papers comprising 63,141 unique surgical cases. Overall, 2043 Forest plots were generated in this meta-analysis and showed that robotic-assisted surgery was associated with less blood loss, fewer surgical complications, and shorter hospital length of stay compared with open surgery, but it costs more than open surgery and takes longer to perform. Robotic-assisted RP was associated with improved continence and potency rates compared with open RP. Positive surgical margin status favored robotic RP, and the recurrence rate was lower in robotic RP and robotic PN. Surprisingly, overall and cancer-specific mortality for radical cystectomy favored robotic surgery. Lymph node yield was also higher for robotic RC. Sensitivity analyses were performed to adjust for baseline characteristics. Dr. Gill explained this surprising result and stressed that the quality of the systemic review is based on the included studies and therefore the oncological outcomes results could be flawed. Only 27% of the included studies were Level 1 or 2 evidence.
Dr. Gill concluded his talk by summarizing the strengths and limitations of their meta-analysis. He highlighted the weakness such as sub-optimal level of evidence of included studies and unable to adjust for unknown covariates. This is the first study to examine the entire spectrum of urologic oncologic surgery over 17 years.
Presented by: Inderbir S. Gill, MD, Chairman of Urology, University of Southern California, Los Angeles, California
Written by: Abhishek Srivastava, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, Pennsylvania, @shekabhishek, at the 19th Annual Meeting of the Society of Urologic Oncology (SUO), November 28-30, 2018 – Phoenix, Arizona