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SIU-WJU Article of the Month – March 2018
Comparison of retropubic, laparoscopic, and robotic radical prostatectomy: which is the winner and how should urologists advise patients?
SIU Academy®. Hakim L. Mar 1, 2018; 212214
Dr. Lukman Hakim
Dr. Lukman Hakim
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Abstract
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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 publica-tions 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 < 0.001) and incontinence (OR: 3.57; 95% CI 2.28–5.58; p < 0.001) were significantly lower after RALP than LRP and equivalent for other comparisons. Total cost was highest for RALP, followed by LRP and ORP.

Conclusions

For PSM and peri- and post-operative complications, RALP showed better results than ORP and LRP. In the context of the biases between the studies, one should interpret the results with caution.

Keywords

Robotics | Laparoscopy | Retropubic | Prostatectomy | Complications | Prostate cancer | MarginsIntroductionProstate.
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