Curative Surgery for Localized Prostate Cancer - Robot-Assisted Versus Laparoscopic Radical Prostatectomy: A Systematic Review of Reviews on Perioperative Efficacy and Safety Outcomes

Rodrigo  Lolli; Matheus Henrique Leite e Silva; Marcelo Esteves Chaves Campos; Marcelo Mamede

doi:10.24915/aup.261

Authors

Rodrigo Lolli Department of Urology, Centro de Pesquisas Oncológicas, Florianópolis, Brazil https://orcid.org/0000-0001-6105-9688
Matheus Henrique Leite e Silva Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil https://orcid.org/0000-0002-6223-043X
Marcelo Esteves Chaves Campos Department of Urology, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil https://orcid.org/0000-0002-8093-8052
Marcelo Mamede Department of Anatomy and Imaging, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil https://orcid.org/0000-0001-5818-0954

DOI:

https://doi.org/10.24915/aup.261

Keywords:

Laparoscopy, Prostatectomy, Prostatic Neoplasms/surgery, Robotic Surgical Procedures

Abstract

Introduction: Several systematic reviews comparing laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) have been published, yielding heterogeneous results. We aimed to summarize this body of evidence.

Methods: A PubMed search was conducted to identify systematic reviews with or without meta-analyses that compared LRP and RARP. Data regarding perioperative parameters, complications, and oncological outcomes were extracted and analyzed.

Results: Intraoperative and postoperative outcomes appear broadly comparable between the two approaches. Most studies demonstrate benefits for RARP in operative time, estimated blood loss, and transfusion rates. Complication rates and positive surgical margin rates tend to be similar. RARP offers a significant advantage over LRP regarding the learning curve for surgeons, albeit at increased cost.

Conclusion: While both techniques yield comparable outcomes, the robotic approach shows modest perioperative benefits.

Study Protocol: PROSPERO database (Registration Number: CRD42025630631).

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References

Ghavamian R, Knoll A, Boczko J, Melman A. Comparison of operative and functional outcomes of laparoscopic radical prostatectomy and radical retropubic prostatectomy: Single surgeon experience. Urology. 2006;67:1241–6.

Romero-Otero J, Touljer K, Guillonneau B. Laparoscopic radical prostatectomy: Contemporary comparison with open surgery. Urologic Oncology: Seminars and Original Investigations. 2007;25:499–504.

Barbash GI, Glied SA. New Technology and Health Care Costs — The Case of Robot-Assisted Surgery. New Engl J Med. 2010;363:701–4.

Liberman D, Trinh QD, Jeldres C, Zorn KC. Is robotic surgery cost-effective: Yes. Curr Opin Urol. 2012;22:61–5.

George EI, Brand TC, LaPorta A, Manescaux J, Satava RM. Origins of Robotic Surgery: From Skepticism to Standard of Care. JSLS. 2018; 22.

Hu JC, O’Malley P, Chughtal B, Isaacs A, Mao J, Wright JD, et al. Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy. J of Urol. 2017; 197:115–21. doi: 10.1016/j.juro.2016.09.115.

Falena I, Dombrovskiy VY, Modi PK, Patel N, Patel R, Salmasi AH, et al. Regional Cost Variations of Robot-Assisted Radical Prostatectomy Compared with Open Radical Prostatectomy. Clin Genitourin Cancer. 2015;13:447–52.

Page MJ, Mckenzie JE, Bossuy PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89. doi: 10.1186/s13643-021-01626-4.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. Guidelines and Guidance The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. PLoS Med. 2009;6:e1000100. doi: 10.1371/journal.pmed.1000100.

Allan C, Ilio D. Laparoscopic versus Robotic-Assisted Radical Prostatectomy for the Treatment of Localised Prostate Cancer: A Systematic Review. Urol Int. 2016;96:373–8.

Steffens D, Tranigasalam R, Leslie S, Maneck B, Young JM, Solomon M. Robotic Surgery in Uro-oncology: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Urology. 2017;106:9–17. doi: 10.1016/j.urology.2017.03.015.

Lee SH, Seo HJ, Lee NR, Son SK, Kim DK, Rha KH. Robot-assisted radical prostatectomy has lower biochemical recurrence than laparoscopic radical prostatectomy: Systematic review and meta-analysis. Investig Clin Urol. 2017;58:152–63. doi: 10.4111/fou.2017.58.3.152. Erratum in: Investig Clin Urol. 2017;58:383. doi: 10.4111/fou.2017.58.5.383.

Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: A systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012;62:1–15.

Ma J, Xu W, Chen R, Zhu Y, Wang Y, Cao W, et al. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies. Int J Surg. 2023;109:1350–9. doi: 10.1097/JS9.0000000000000193.

Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, et al. Robot-assisted radical prostatectomy is more beneficial for prostate cancer patients: A system review and meta-analysis. Med Sci Monit. 2018;24:272–287. doi: 10.12659/msm.907092.

Huang X, Wang L, Zheng X, Wang X. Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc. 2017;31:1045–60. doi: 10.1007/s00464-016-5125-1.

Robertson C, Close A, Fraser C, Gurung T, Jia X, Sharma P, et al. Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: A systematic review and mixed treatment comparison meta-analysis. BJU Int. 2013;112:798–812. doi: 10.1111/bju.12247.

Moran PS, O’Neill M, Teljeur C, Flattery M, Murphy LA, Smyth G, et al. Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: A systematic review and meta-analysis. Int J Urol. 2013;20:312–21. doi: 10.1111/ju.12070.

Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol. 2012;62:431–52. doi: 10.1016/j.eururo.2012.05.044.

Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62:405–17. doi: 10.1016/j.eururo.2012.05.045.

Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012;62:418–30. doi: 10.1016/j.eururo.2012.05.046.

Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, et al. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol. 2012;62:382–404. doi: 10.1016/j.eururo.2012.05.047.

Ramsay C, Pickard R, Robertson C, Close A, Vale L, Armstrong N, et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess. 2012;16:1–313.

Heer R, Raymond I, J. Jackson JM, A. Soomro N. A critical systematic review of recent clinical trials comparing open retropubic, laparoscopic and robot-assisted laparoscopic radical prostatectomy. Rev Recent Clin Trials. 2011;6:241–9.

Parsons JK, Bennett JL. Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology. 2008;72:412–6. doi: 10.1016/j.urology.2007.11.026.

Wang CJ, Pang CC, Qin J, Chen CX, Huang HT, Li HY, et al. A comprehensive examination and meta-analysis evaluating perioperative, oncological, and functional results of robotic-assisted radical prostatectomy (RARP) in comparison to three-dimensional laparoscopic radical prostatectomy (3D LRP). J Robot Surg. 2024;18:356. doi: 10.1007/s11701-024-02110-6.

Carbonara U, Srinath M, Crocerossa F, Ferro M, Cantiello F, Lucarelli G, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol. 2021;393721–32. doi: 10.1007/s00345-021-03687-5.

Rozet F, Harmon J, Cathelineau X, Barret E, Vallancien G. Robot-assisted versus pure laparoscopic radical prostatectomy. World J Urol. 2006;24:171–9.

Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, et al. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009;104:534–9. doi: 10.1111/j.1464-410X.2009.08419.x.