Basiri A, et al. - Herein, authors undertook an appraisal of the 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) in prostate cancer patients. Data disclosed that RALP demonstrated better results when compared to ORP and LRP for positive surgical margin (PSM) and peri- and post-operative complications. Owing to the biases between the studies, cautious interpretation of the results was recommended.

Methods

• Data was extracted from 104 original research articles representing 227,400 patients.
• An appraisal was performed of PubMed/Medline, Scopus, Google Scholar, EMBASE and the Cochrane Library in December 2016.
• Researchers selected 104 publications for inclusion.
• Positive surgical margin (PSM) and major complication rate according to Clavien classifications served as the primary outcomes.
• Secondary outcomes included 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

• Findings illustrated that ORP had a markedly higher rate for PSM than RALP (OR: 1.18; 95% CI 1.05-1.32; p=0.004).
• However, the rate of PSM did not exhibit any notable change between ORP vs LRP (OR: 1.37; 95% CI 0.88-2.14; p=0.17) and RALP vs LRP (OR: 0.83; 95% CI 0.40-1.72; p=0.62).
• A prominent variation was noted in the major Clavien complication rate between ORP and RALP (OR: 2.14; 95% CI 1.24-3.68; p=0.006).
• Data estimated low blood loss, transfusions and length of hospital stay for RALP, moderate for LRP and high for ORP.
• Substantially lower 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 discovered after RALP than LRP, which were equivalent for other comparisons.
• It was deduced that the total cost was highest for RALP, followed by LRP and ORP.