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Robot‐assisted radical prostatectomy compared with open and laparoscopic approaches: A systematic review and meta‐analysis
Author(s) -
Moran Patrick S,
O'Neill Michelle,
Teljeur Conor,
Flattery Martin,
Murphy Linda A,
Smyth Gordon,
Ryan Máirín
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12070
Subject(s) - medicine , confidence interval , prostatectomy , relative risk , meta analysis , sexual function , open prostatectomy , urology , laparoscopy , laparoscopic radical prostatectomy , surgery , prostate cancer , cancer
Medline and E mbase were searched for studies comparing robot‐assisted radical prostatectomy with open prostatectomy and conventional laparoscopic prostatectomy. Random effects meta‐analysis was used to calculate a pooled estimate of effect. The 95% prediction intervals are also reported. One randomized study and 50 observational studies were identified. The results show that compared with open surgery, robot‐assisted surgery is associated with fewer positive surgical margins for pT2 tumors (relative risk 0.63, 95% confidence interval 0.49–0.81, P < 0.001) and improved outcomes for sexual function at 12 months (relative risk 1.60, 95% confidence interval 1.33–1.93, P = <0.001), and, to a lesser extent, urinary function at 12 months (relative risk 1.06, 95% confidence interval 1.02–1.11, P < 0.01). Compared with conventional laparoscopic prostatectomy, robot‐assisted surgery is associated with a slight increase in urinary function at 12 months (relative risk 1.09, 95% confidence interval 1.02 to 1.17, P = 0.013). The overall methodological quality of the included studies was low, with high levels of heterogeneity. The use of prediction intervals as an aid to decision making in regard to the introduction of this technology is examined. Clinically significant improvements in positive surgical margins rates for pT2 tumors and sexual function at 12 months associated with robot‐assisted surgery in comparison with open surgery should be interpreted with caution given the limitations of the evidence. Differences between robot‐assisted and conventional laparoscopic surgery are minimal.