Robot‐assisted radical prostatectomy in the <scp>K</scp>orean population: A 5‐year propensity‐score matched comparative analysis versus open radical prostatectomy

Koo, Kyo Chul; Tuliao, Patrick; Yoon, Young Eun; Chung, Byung Ha; Hong, Sung Joon; Yang, Seung Choul; Rha, Koon Ho

doi:10.1111/iju.12447

Cited by 17 publications

(11 citation statements)

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“…All of the included studies reported exclusion/inclusion criteria [ 7 – 39 ]. The 19 studies [ 8 , 10 , 14 , 16 – 20 , 22 , 23 , 27 , 29 , 30 – 33 , 36 – 38 ] that compared the outcomes between ORP and RARP groups included 16 830 prostate cancer patients. Eleven of these studies [ 7 , 9 – 13 , 15 , 21 , 34 , 35 ] compared the outcomes between LRP and RARP, and 5 studies [ 10 , 24 – 26 , 39 ] compared the outcomes between ORP and LRP.…”

Section: Resultsmentioning

confidence: 99%

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Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis

Long²,

Guan³

et al. 2018

Med Sci Monit

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BackgroundRobot-assisted radical prostatectomy (RARP) is increasingly used worldwide, but comparisons of perioperative, functional, and oncologic outcomes among RARP, laparoscopic radical prostatectomy (LRP), and open radical prostatectomy (ORP) remain inconsistent.Material/MethodsSystematic literature searches were conducted using EMBASE, PubMed, the Cochrane Library, CNKI, and Science Direct/Elsevier up to April 2017. A meta-analysis was conducted using Review Manager and Stata software.ResultsWe included 33 studies. Meta-analysis revealed that blood loss, transfusion rate, and positive surgical margin (PSM) rate were significantly lower following RARP compared with LRP (SMD (95% confidence interval [CI]) 0.31 [0.01, 0.61]; combined ORs (95% CI) 5.32 [1.29, 21.98]; 1.27 [1.10, 1.46]) and ORP (SMD (95% CI) 0.75 [0.30, 1.21]; and combined ORs (95% CI) 3.44 [1.21, 9.79]); positive surgical margin (PSM) rates were significantly lower following RARP compared with LRP (combined ORs (95% CI) 1.27 [1.10, 1.46]), but not ORP. Operation time was also shorter for RARP than for LRP. The rates of nerve-sparing, recovery of complete urinary continence, and recovery of erectile function were significantly higher following RARP compared with LRP (combined ORs (95% CI) 0.55 [0.31, 0.95]; 0.66 [0.55, 0.78]; 0.46 [0.30, 0.71]) and ORP (combined ORs (95% CI) 0.36 [0.21, 0.63]; 0.33 [0.15, 0.74]; 0.65 [0.37, 1.14]).ConclusionsThis meta-analysis demonstrates that RARP results in better overall outcomes than LRP and ORP in terms of blood loss, transfusion rate, nerve sparing, urinary continence and erectile dysfunction recovery, and suggests that RARP offers better results than LRP and ORP in treatment of prostate cancer. However, studies with larger sample sizes and long-term results are needed.

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Section: Resultsmentioning

confidence: 99%

“…Our results thus differed from the previous studies. The prostatic apex was reported to be the most common location of PSM, and improved visualization of the prostatic apex during RARP may reduce the risk of PSM [ 8 , 50 – 53 ].…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis

Long²,

Guan³

et al. 2018

Med Sci Monit

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“…However, the results showed that PSM rates in pT2 cancers was lower in RARP (OR:0.77; 95% CI: 0.63 to 0.95; P = 0.01)(Figure 9 ). Four studies [ 20 , 43 , 60 , 73 ] comparing mean lymph node yield and the results showed that lymph node yield is higher in RARP (WMD: 1.61; 95% CI: 1.18 to 2.05; P < 0.001)( Figure S9 ), and 16 studies [ 20 , 26 , 33 , 34 , 39 , 49 , 58 , 61 , 64 - 68 , 73 , 84 , 85 ] reported on positive lymph node, There was a statistical differences decreased positive lymph node in RARP than RRP (OR:0.45; 95% CI: 0.31 to 0.65; P < 0.001)(Figure 10 ).…”

Section: Resultsmentioning

confidence: 99%

Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and a meta-analysis update

et al. 2016

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CONTEXTThe safety and feasibility of robotic-assisted radical prostatectomy (RARP) compared with retropubic radical prostatectomy(RRP) is debated. Recently, a number of large-scale and high-quality studies have been conducted.OBJECTIVETo obtain a more valid assessment, we update the meta-analysis of RARP compared with RRP to assessed its safety and feasibility in treatment of prostate cancer.METHODSA systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared RARP with RRP. Outcomes of interest included perioperative, pathologic variables and complications.RESULTS78 studies assessing RARP vs. RRP were included for meta-analysis. Although patients underwent RRP have shorter operative time than RARP (WMD: 39.85 minutes; P < 0.001), patients underwent RARP have less intraoperative blood loss (WMD = -507.67ml; P < 0.001), lower blood transfusion rates (OR = 0.13; P < 0.001), shorter time to remove catheter (WMD = -3.04day; P < 0.001), shorter hospital stay (WMD = -1.62day; P < 0.001), lower PSM rates (OR:0.88; P = 0.04), fewer positive lymph nodes (OR:0.45;P < 0.001), fewer overall complications (OR:0.43; P < 0.001), higher 3- and 12-mo potent recovery rate (OR:3.19;P = 0.02; OR:2.37; P = 0.005, respectively), and lower readmission rate (OR:0.70, P = 0.03). The biochemical recurrence free survival of RARP is better than RRP (OR:1.33, P = 0.04). All the other calculated results are similar between the two groups.CONCLUSIONSOur results indicate that RARP appears to be safe and effective to its counterpart RRP in selected patients.

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“…In our previous report, we found that RARP and ORP had an equal oncological outcome without a significant difference in terms of 5-year BCRFS (P = 0.651), MFS (P = 0.876) and CSS (P = 0.076). 29 Furthermore, in a recent systematic review and meta-analysis comparing the oncological outcomes of RARP and ORP, the authors showed similar overall PSM rates (RARP vs ORP: OR 1.21; P = 0.19) and BCRFS rates (RARP vs ORP: HR 0.9; P = 0.526). 30 Regarding laparoscopic radical prostatectomy, Guillonneau et al reported 91% BCRFS at 3-year follow up in 1000 patients; in addition, Touijer et al showed overall 5-and 8-year BCRFS rates of 78% and 71%, respectively.…”

Section: Discussionmentioning

confidence: 96%

Stratified analysis of 800 Asian patients after robot‐assisted radical prostatectomy with a median 64 months of follow up

et al. 2016

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Objective: To report the 5-year oncological outcomes of robot-assisted radical prostatectomy from the largest series ever reported from Asia. Methods: A retrospective analysis of 800 Asian patients who were treated with robotassisted radical prostatectomy from July 2005 to May 2010 in the Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea was carried out. The primary end-point was to evaluate the biochemical recurrence. The secondary end-point was to show the biochemical recurrence-free survival, metastasisfree survival and cancer-specific survival. Results: A total of 197 (24.65%), 218 (27.3%), and 385 (48.1%) patients were classified as low-, intermediate-and high-risk patients according to the D'Amico risk stratification risk criteria, respectively. The median follow-up period was 64 months (interquartile range 28-71 months). The overall incidence of positive surgical margin was 36.6%. There was biochemical recurrence in 183 patients (22.9%), 38 patients (4.8%) developed distant metastasis and 24 patients (3%) died from prostate cancer. Actuarial biochemical recurrence-free survival, metastasis-free survival, and cancer-specific survival rates at 5 years were 76.4%, 94.6% and 96.7%, respectively. Positive lymph node was associated with lower 5-year biochemical recurrence-free survival (9.1%), cancer-specific survival (75.7%) and metastasis-free survival (61.9%) rates (P < 0.001). On multivariable analysis, among all the predictors, positive lymph node was the strongest predictor of biochemical recurrence, cancer-specific survival and metastasis-free survival (P < 0.001). Conclusions: Herein we report the largest robot-assisted radical prostatectomy series from Asia. Robot-assisted radical prostatectomy is confirmed to be an oncologically safe procedure that is able to provide effective 5-year cancer control, even in patients with high-risk disease.

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Robot‐assisted radical prostatectomy in the Korean population: A 5‐year propensity‐score matched comparative analysis versus open radical prostatectomy

Abstract: Robot-assisted laparoscopic radical prostatectomy represents an effective surgical approach for the treatment of prostate cancer in the Korean population, as it provides equivalent oncological outcomes to open radical prostatectomy.

Cited by 17 publications

References 20 publications

Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis

Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis

Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and a meta-analysis update

Stratified analysis of 800 Asian patients after robot‐assisted radical prostatectomy with a median 64 months of follow up

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