Open, laparoscopic, and robot-assisted radical prostatectomy oncological results: a reverse systematic review by Tomás Bernardo Costa Moretti

J Endourol. 2023 Mar 16. doi: 10.1089/end.2022.0819. Online ahead of print.


OBJECTIVE: to apply the Reverse Systematic Review (RSR) to compare three radical prostatectomies (RP) techniques: open (RRP), laparoscopic (LRP), and robotic (RARP) in relation to oncological outcomes: positive surgical margin (PSM) and biochemical recurrence rate (BCR).

EVIDENCE ACQUISITION: a search was carried out in 8 databases between 2000 and 2020 through SR studies referring to RRP, LRP, or RARP (80 SR). All references used in these SRs were captured referring to 1,724 reports. Preoperative and oncological outcomes were compared and correlated among RRP, LRP, and RARP.

EVIDENCE SYNTHESIS: 559 (32.4%) reports for RRP, 413 (23.9%) for LRP, and 752 (43.7%) for RARP, and a total of 1,353,485 patients were found. Regarding PSM, 284 reports were collected for RRP, 324 for LRP, and 499 for RARP, with rates of 23.6%, 20.7%, and 19.2%, respectively, and only the RRP with a statistical difference (P<0.001). Using a non-linear regression model, the BCR rate was correlated with follow-up time at 1, 2, 3, 5, 7, and 10 years: 10%, 15%, 18%, 20%, 23 %, and 38% for RRP; 6%, 9%, 13%, 20%, 23%, 10% for LRP; 8%, 12%, 16%, 23%, 27%, 19% for RARP. The absence of long-term work for RARP prevented more accurate projections of BCR.

CONCLUSIONS: RSR proved to be effective in generating a population and heterogeneous sample capable of demonstrating better oncological results for minimally invasive surgery (LRP and RARP) compared to RRP. It demonstrated the maturity of temporal follow-up data for RRP and LRP and the impact of lack of late follow-up from RARP studies on the long-term rate of BC.

PMID:36924303 | DOI:10.1089/end.2022.0819