Due to the lack of sufficient evidence, it is not clear whether robotic-assisted radical prostatectomy (RARP) or laparoscopic radical prostatectomy (LRP) is better for prostate cancer. We conducted this study by separately pooling and analysing randomised controlled trials (RCTs) and non-randomised studies to compare the perioperative, functional, and oncologic outcomes between RARP and LRP.
A systematic literature search was performed in March 2022 using Cochrane Library, Pubmed, Embase, Medline, Web of Science, and China National Knowledge Infrastructure. Two independent reviewers performed literature screening, data extraction and quality assessment according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Subgroup analysis and sensitivity analysis were performed.
A total of 46 articles were included, including 4 from 3 RCTs and 42 from non-randomised studies. For RCTs, meta-analysis showed that RARP and LRP were similar in blood loss, catheter indwelling time, overall complication rate, overall positive surgical margin and BCR rates, but quantitative synthesis of non-randomised studies showed that RARP was associated with less blood loss (WMD=-71.99, 95% CI -99.37~-44.61, P<0.001), shorter catheterization duration (WMD=-1.03, 95% CI -1.84~-0.22, P=0.010), shorter hospital stay (WMD=-0.41, 95% CI -0.68~-0.13, P=0.004), lower transfusion rate (OR=0.44, 95% CI 0.35~0.56, P<0.001), lower overall complication rate (OR=0.72, 95% CI 0.54~0.96, P=0.020), and lower BCR rate (OR=0.78, 95% CI 0.66~0.92, P=0.004), compared with LRP. Both meta-analysis of RCTs and quantitative synthesis of non-randomised studies showed that RARP was associated with improved functional outcomes. From the results of the meta-analysis of RCTs, RARP was higher than LRP in terms of overall continence recovery (OR=1.60, 95% CI 1.16~2.20, P=0.004), overall erectile function recovery (OR=4.07, 95% CI 2.51~6.60, P<0.001), continence recovery at 1 (OR=2.14, 95% CI 1.25~3.66, P=0.005), 3 (OR=1.51, 95% CI 1.12~2.02, P=0.006), 6 (OR=2.66, 95% CI 1.31~5.40, P=0.007), and 12 months (OR=3.52, 95% CI 1.36~9.13, P=0.010) postoperatively, and potency recovery at 3 (OR=4.25, 95% CI 1.67~10.82, P=0.002), 6 (OR=3.52, 95% CI 1.31~9.44, P=0.010), and 12 months (OR=3.59, 95% CI 1.78~7.27, P<0.001) postoperatively, which were consistent with the quantitative synthesis of non-randomised studies. When sensitivity analysis was performed, the results remained largely unchanged, but the heterogeneity among studies was greatly reduced.
This study suggests that RARP can improve functional outcomes compared with LRP. Meanwhile, RARP has potential advantages in perioperative and oncologic outcomes.
International journal of surgery (London, England). 2023 Apr 19 [Epub ahead of print]
Jianglei Ma, Weidong Xu, Rui Chen, Yasheng Zhu, Ye Wang, Wanli Cao, Guanqun Ju, Jizhong Ren, Xiaofei Ye, Qian He, Yifan Chang, Shancheng Ren
Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai 200003, China., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China., Department of Health Statistics, Naval Medical University, Shanghai 200433, China.