Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies.

TY - JOUR

T1 - Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies.

AU - Ficarra, Vincenzo

AU - Novara, Giacomo

AU - Artibani, Walter

AU - Cestari, Andrea

AU - Galfano, Antonio

AU - Graefen, Markus

AU - Guazzoni, Giorgio

AU - Guillonneau, Bertrand

AU - Menon, Mani

AU - Montorsi, Francesco

AU - Patel, Vipul

AU - Rassweiler, Jens

AU - Hendrik, Van Poppel

PY - 2009

Y1 - 2009

N2 - CONTEXT: Despite the wide diffusion of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), only few studies comparing the results of these techniques with the retropubic radical prostatectomy (RRP) are currently available. OBJECTIVE: To evaluate the perioperative, functional, and oncologic results in the comparative studies evaluating RRP, LRP, and RALP. EVIDENCE ACQUISITION: A systematic review of the literature was performed in January 2008, searching Medline, Embase, and Web of Science databases. A "free-text" protocol using the term radical prostatectomy was applied. Some 4000 records were retrieved from the Medline database; 2265 records were retrieved from the Embase database;, and 4219 records were retrieved from the Web of Science database. Three of the authors reviewed the records to identify comparative studies. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK). EVIDENCE SYNTHESIS: Thirty-seven comparative studies were identified in the literature search, including a single, randomised, controlled trial. With regard to the perioperative outcome, LRP and RALP were more time consuming than RRP, especially in the initial steps of the learning curve, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates all favoured LRP. With regard to the functional results, LRP and RRP showed similar continence and potency rates. Similarly, no significant differences were identified between LRP and RALP, while a single, nonrandomised, prospective study suggested advantages in terms of both continence and potency recovery after RALP, compared with RRP. With regard to the oncologic outcome, LRP and RALP were associated with positive surgical margin rates similar to those of RRP. CONCLUSIONS: The quality of the available comparative studies was not excellent. LRP and RALP are followed by significantly lower blood loss and transfusion rates, but the available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. Further high-quality, prospective, multicentre, comparative studies are needed.

AB - CONTEXT: Despite the wide diffusion of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), only few studies comparing the results of these techniques with the retropubic radical prostatectomy (RRP) are currently available. OBJECTIVE: To evaluate the perioperative, functional, and oncologic results in the comparative studies evaluating RRP, LRP, and RALP. EVIDENCE ACQUISITION: A systematic review of the literature was performed in January 2008, searching Medline, Embase, and Web of Science databases. A "free-text" protocol using the term radical prostatectomy was applied. Some 4000 records were retrieved from the Medline database; 2265 records were retrieved from the Embase database;, and 4219 records were retrieved from the Web of Science database. Three of the authors reviewed the records to identify comparative studies. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK). EVIDENCE SYNTHESIS: Thirty-seven comparative studies were identified in the literature search, including a single, randomised, controlled trial. With regard to the perioperative outcome, LRP and RALP were more time consuming than RRP, especially in the initial steps of the learning curve, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates all favoured LRP. With regard to the functional results, LRP and RRP showed similar continence and potency rates. Similarly, no significant differences were identified between LRP and RALP, while a single, nonrandomised, prospective study suggested advantages in terms of both continence and potency recovery after RALP, compared with RRP. With regard to the oncologic outcome, LRP and RALP were associated with positive surgical margin rates similar to those of RRP. CONCLUSIONS: The quality of the available comparative studies was not excellent. LRP and RALP are followed by significantly lower blood loss and transfusion rates, but the available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. Further high-quality, prospective, multicentre, comparative studies are needed.

KW - Humans

KW - Male

KW - Quality of Life

KW - Urinary Incontinence epidemiology

KW - Treatment Outcome

KW - Prognosis

KW - Prostatic Neoplasms mortality

KW - Risk Assessment

KW - Erectile Dysfunction epidemiology

KW - Laparoscopy adverse effects

KW - Length of Stay

KW - Pain, Postoperative physiopathology

KW - Postoperative Complications epidemiology

KW - Prostatectomy adverse effects

KW - Robotics

KW - Survival Rate

KW - Urologic Surgical Procedures, Male adverse effects

KW - Humans

KW - Male

KW - Quality of Life

KW - Urinary Incontinence epidemiology

KW - Treatment Outcome

KW - Prognosis

KW - Prostatic Neoplasms mortality

KW - Risk Assessment

KW - Erectile Dysfunction epidemiology

KW - Laparoscopy adverse effects

KW - Length of Stay

KW - Pain, Postoperative physiopathology

KW - Postoperative Complications epidemiology

KW - Prostatectomy adverse effects

KW - Robotics

KW - Survival Rate

KW - Urologic Surgical Procedures, Male adverse effects

M3 - SCORING: Zeitschriftenaufsatz

VL - 55

SP - 1037

EP - 1063

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 5

M1 - 5

ER -