Objectives: To compare outcomes of radical retropubic, laparoscopic, and robotic-assisted prostatectomy using evidence-based analysis.
Methods: We performed meta-analysis of observational studies directly comparing radical retropubic, laparoscopic, and robotic-assisted prostatectomy for the treatment of localized prostate cancer. The primary outcomes were operative blood loss, perioperative transfusion, surgical margin status, postoperative urinary incontinence, and postoperative erectile dysfunction. Based on established similarities in surgical principles, we combined laparoscopic and robotic-assisted data into a single group. We estimated standardized mean differences (SMD), risk ratios (RR), and risk differences (RD) using random effects models.
Results: Nineteen studies (n = 3893 patients) met inclusion criteria for this analysis. Compared with those undergoing retropubic prostatectomy, patients undergoing laparoscopic or robotic-assisted prostatectomy experienced less operative blood loss (SMD -1.74, 95% confidence interval [CI] -1.74 to -1.49, P <0.001) and were 77% less likely to receive a perioperative transfusion (RR 0.23, 95% CI 0.11 to 0.49, P <0.001). There was no significant difference in overall risk of positive surgical margin (RR 0.88, 95% CI 0.74 to 1.06, P = 0.17). There were also no significant differences in 1-year urinary continence (P = 0.49) and 1-year erectile function (P = 0.09); however, these outcomes were measured using nonvalidated instruments.
Conclusions: Our results suggest that, compared with retropubic prostatectomy, laparoscopic and robotic-assisted prostatectomy are associated with decreased operative blood loss, decreased risk of transfusion, and similar risk of positive surgical margin. Further comparative studies-using consistent, validated outcomes measures-are needed to further assess postoperative urinary continence and potency.