A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_med-2019-0052_s_006_w2aab3b7d238b1b6b1aab1c15b1Aa"><jats:title>Objective</jats:title><jats:p>To evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.</jats:p></jats:sec><jats:sec id="j_med-2019-0052_s_007_w2aab3b7d238b1b6b1aab1c15b2Aa"><jats:title>Methods</jats:title><jats:p>Meta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.</jats:p></jats:sec><jats:sec id="j_med-2019-0052_s_008_w2aab3b7d238b1b6b1aab1c15b3Aa"><jats:title>Results</jats:title><jats:p>This meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P&lt;0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).</jats:p></jats:sec><jats:sec id="j_med-2019-0052_s_009_w2aab3b7d238b1b6b1aab1c15b4Aa"><jats:title>Conclusion</jats:title><jats:p>As an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.</jats:p></jats:sec>

Role of laparoscopy in the era of robotic surgery in urology in developing countries

“…Wang et al . [ 11 ] reported a meta-analysis consisting of mostly observational studies comparing LRP with RARP. The authors found that EBL (95% CI, [-0.84, 0.08]) and positive surgical margin (PSM) rate (odds ratio [OR] 0.97, 95% CI, [0.76, 1.24]) was not significantly different between LRP and RARP.…”

Perioperative outcomes of robot-assisted laparoscopic radical prostatectomy (RALRP) and LRP in patients with prostate cancer based on risk groups

“…In 2013, RALRP was introduced at the Ramathibodi Hospital. In many studies in the past, RALRP has been shown to be more advantageous than LRP [ 17 ] in terms of EBL, operative time, blood transfusion rate, LOS, and adjacent organ injury rate. According to previous studies [ 11 , 18 ], there are ample data from high-volume centres reporting that RALRP has the advantages of fewer postoperative complications compared with LRP.…”

“…There are plenty of study data from high-volume centres that have reported on LRP and RALRP as MIS techniques worldwide. A meta-analysis [8] showed that RALRP, with its advantages of few postoperative complications and well-preserved urinary continence and erectile function, was an effective, and safe option for prostate cancer [8,9]. In Thailand, the cost of treatment with RALRP and LRP differs [10], so the total cost is a factor that determines the choice of treatment in shared doctor-patient decisions.…”

Robotic Surgery in Oncology

“…Robotic surgeries in cancer with definitive advantage in terms of ease of surgery and marginal benefits in patient outcome are: & Anterior resection or APR with TME and ANP in carcinoma rectum [4] & Nerve sparing prostatectomy in carcinoma prostate [10] & Partial nephrectomy [11] & Mediastinal tumors [12] & Metastatectomy in the lung, wedge resection, and lobectomy in carcinoma lung [13] & Transoral robotic surgery (TORS) for small pharyngeal wall tumors, tongue base malignancy (avoids mandibulotomy) [14] & Surgery for carcinoma endometrium [15] Though many other procedures are being done robotically, the advantage is not clearly demonstrated with present evidence. However, continued effort and well-conducted studies to look into the long-term outcome may change the opinion in near future.…”