Startseite A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy
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A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy

  • Tao Wang , Qunsuo Wang und Songtao Wang EMAIL logo
Veröffentlicht/Copyright: 11. Juni 2019
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Open Medicine
Aus der Zeitschrift Open Medicine Band 14 Heft 1

Abstract

Objective

To evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.

Methods

Meta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.

Results

This meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P<0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).

Conclusion

As an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.

Keywords: Prostate cancer; Robot-assisted laparoscopic; Laparoscopy; Meta-analysis

1 Introduction

Prostate cancer is one of the most common malignant tumors in older men [1]. At present, the main surgical treatment methods include open surgery, retro-pubic laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy [2]. With the rapid development of minimally invasive techniques, laparoscopic techniques have been increasingly applied to urological surgery [3], and the most important minimally invasive procedures include retropubic laparoscopic radical prostatectomy (LRP) and robotic assisted laparoscopic prostate (RALP), both of which have the advantages of small surgical incisions, less trauma, less bleeding, fewer post-operative complications, faster recovery, shorter hospital stay, etc.. However, which technique is better is still controversial. For this reason, this study used the meta analysis method to provide an evidence-based medical basis for treatment decisions regarding clinical prostate cancer.

2 Methods

2.1 Searching method

We conducted a search of PubMed, Ovid, ScineceDirect, and EMBASE from 2005 to 2018. We developed a search strategy as outlined by the Cochrane Collaboration Workbook. The medical subject heading terms and keywords included “prostate cancer prostatectomy”, “radical prostatectomy laparoscopy”, “assisted-laparoscopic”. We excluded duplicate articles and unpublished studies from international conferences.

2.2 Inclusion criteria

(1) The patients that were diagnosed with localized prostate cancer treated for the first time, and all had indications for treatment by radical prostatectomy. (2) The literature compared the difference in efficacy between RALP and LRP. (3) The study was designed as a prospective controlled study or a retrospective case-control study. (4) The literature involved at least one of the following seven indicators: operation time, intraoperative blood loss, blood transfusion rate, surgical margin positive rate and hospitalization time, postoperative urinary function and postoperative complications, and follow-up time more than 1 year.

2.3 Exclusion criteria

The following criteria were used to exclude literature: non-clinical controlled trials, non-prostate cancer studies, other surgical treatments or data descriptions were unclear.

2.4 Data extraction

The literature was selected according to the inclusion/exclusion criteria, and the parallel extraction method was used, which was completed by two researchers and cross-examined. When the opinions were inconsistent, decisions to include or exclude literature were resolved through discussion. Any lack of information was supplemented by contact with the author, which included basic information about the subject, including patient numbers, characteristics, interventions, and outcome measures. Literature quality evaluation: The methodological quality of the randomized controlled trial literature included in the study was based on the Jadad quality scoring method, including randomization, blinding, etc.

2.5 Statistical analysis

Meta analysis was performed using RevMan 5.3 software recommended by the Cochrane Collaboration. If the two categorical variables were used, the odds ratios and their 95% confidence intervals were used to describe the results. P < 0.05 was considered statistically significant. If it was a continuous variable, the weighted mean difference (WMD) was used to describe the results. The included studies were simultaneously tested for homogeneity. If the study data was not heterogeneous, a fixed effect model is used; if heterogeneity exists, the sensitivity analysis is used to filter heterogeneous study heterogeneity. If there was clinical consistency, a random effect model was used, and vice versa, descriptive analysis is used.

3 Results

3.1 Literature searches and characteristics of eligible studies

Figure 1 shows the flow diagram of the study selection process. After further screening, we obtained 22 studies. Table 1 summarizes the detailed characteristics of the 22 eligible studies.

Figure 1 The study selection process
Figure 1

The study selection process

Table 1

Baseline characteristics of included studies

References Group NO. of patients Mean age (years)
Coelho 2010 [9] RALP 250 60.4
LRP 250 62.9
Drouin 2009 [10] RALP 71 60.4
LRP 85 61.8
Ficarra 2007 [11] RALP 40 62.8
LRP 40 63.1
Finkelstein 2010 [12] RALP 2841 61.3
LRP 168 63.6
Hakimi 2009 [13] RALP 75 59.8
LRP 75 59.6
Hu 2006 [14] RALP 322 63.7
LRP 358 62.1
Joseph 2005 [15] RALP 50 59.6
LRP 50 61.8
Magheli 2011 [16] RALP 522 58.3
LRP 522 58.4
Menon 2002 [17] RALP 40 60.7
LRP 40 62.8
Papachristos 2015 [18] RALP 100 60.5
LRP 100 62.5
Park 2013 [19] RALP 183 63
LRP 144 67
Porpiglia 2013 [20] RALP 60 63.9
LRP 60 64.7
Rozet 2007 [21] RALP 133 62
LRP 133 62.5
Tozawa 2014 [22] RALP 157 67
LRP 551 67.4
Trabulsi 2011 [23] RALP 205 59.9
LRP 45 58.1
Willis 2012 [24] RALP 121 58.1
LRP 161 58

3.2 Meta-analysis of surgical blood loss of RALP and LRP

Surgical blood loss was reported in nine studies (Figure 2). Compared with LRP, RALP was associated with a 0.38 reduction in blood loss (95% CI, [-0.84, 0.08]. Significant heterogeneity was found among these studies (I2=95%, P < 0.00001). Due to significant heterogeneity of the data, we used a random effect model. According to our analysis, the difference between RALP and LRP was not significant.

Figure 2 The forest plot for surgical blood loss of RALP and LRP groups
Figure 2

The forest plot for surgical blood loss of RALP and LRP groups

3.3 Meta-analysis of the postoperative complications of RALP and LRP

The number of postoperative complications was reported in eight studies (Figure 3). Data from these 8 studies was analyzed in a fixed effect model and the pooled OR was 0.57 (95% CI, [0.46, 0.70]). The I2 estimate of the variance between the studies is 35% and P = 0.16, which showed low heterogeneity. According to our analysis, the postoperative complications between RALP and LRP was significant. (P < 0.00001).

Figure 3 The forest plot for postoperative complications of RALP and LRP groups
Figure 3

The forest plot for postoperative complications of RALP and LRP groups

3.4 Meta-analysis of the postoperative urinary continence rate 1 year after RALP and LRP

The postoperative urinary continence rate 1 year after surgery was reported in eight studies (Figure 4). The fixed effects model was used. The meta-analysis demonstrated that patients with RALP had significantly lower postoperative urinary continence rates 1 year after surgery compared with LRP (OR=2.09; 95% CI, [1.61, 2.73]). The I2 estimate of the variance between these studies is 0% and P = 0.73, which showed no significant heterogeneity. According to our analysis, the postoperative urinary continence rate 1 year after RALP was lower than LRP (P < 0.00001).

Figure 4 The forest plot for the postoperative urinary continence rate 1 year after RALP and LRP
Figure 4

The forest plot for the postoperative urinary continence rate 1 year after RALP and LRP

3.5 Meta-analysis of the rate of positive surgical margins of RALP and LRP

The rate of positive surgical margins was reported in twelve studies (Figure 5). The fixed effects model was used. The meta-analysis shows that the rate of positive surgical margins of RALP and LRP was not significant (P = 0.82) and the pooled OR was 0.97 (95% CI, [0.76, 1.24]). The I2 is 43% and P = 0.06, which indicate low heterogeneity. According to our analysis, the rate of positive surgical margins of RALP and LRP was not significant (P = 0.82).

Figure 5 The forest plot for the rate of positive surgical margins of RALP and LRP
Figure 5

The forest plot for the rate of positive surgical margins of RALP and LRP

4 Discussion

Because patients and their family members have the right to self-selection (taking into account economic and local medical conditions, etc.) [4], it is unrealistic to find completely randomized controlled studies. Therefore, most of the literature we have included are prospective and non-random controlled trials or retrospective controlled studies.

There are many complications after radical prostatectomy, including anastomotic leakage, anastomotic stenosis, rectal injury, urinary incontinence, and erectile dysfunction [5]. Due to the limited number of published studies and data values, this study analyzed the incidence of postoperative complications in general, and the results showed that robot-assisted laparoscopy was lower.

The main advantage of robot-assisted laparoscopic surgery is to simulate the standard steps of traditional laparoscopic surgery [6]. In the narrow pelvic space, the flexible robotic arm makes the anatomical operation finer than the human hand, and it is easier to preserve the integrity of the nerve [7]. The urinary structure is maintained in tumor resection and sexual function and complete urinary control is retained. However, its main disadvantages are high cost (including cost, maintenance and consumables). The cost problem has limited the widespread promotion of robot-assisted laparoscopy in the clinic [8], but we believe that it may be reduced in the future through improvement.

Limitations of this paper and future research directions: Due to the limitation of the number and quality of the included literature, and the lack of grey literature, these factors may cause deviation of the analysis results; therefore, it is necessary to further study the long-term follow-up effects of the two procedures. This should provide more strong evidence for clinical practice and research work.

In summary, robot-assisted laparoscopic surgery is safer and more effective than laparoscopic radical prostatectomy, but more prospective randomized controlled trials are needed for further validation. Looking to the future, robotic assistive technology will be more widely used in the clinical treatment of prostate cancer.

  1. Conflict of interest: Authors state no conflict of interest.

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Received: 2018-08-25
Accepted: 2018-10-13
Published Online: 2019-06-11

© 2019 Tao Wang et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.1515/med-2019-0052
Schlagwörter für diesen Artikel
Prostate cancer; Robot-assisted laparoscopic; Laparoscopy; Meta-analysis
Creative Commons
BY-NC-ND 4.0

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  27. Computed tomography findings in patients with Samter’s Triad: an observational study
  28. Case Report
  29. A spinal subdural hematoma induced by guidewire-based lumbar drainage in a patient with ruptured intracranial aneurysms
  30. Research Article
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  33. Oncoprotein LAMTOR5 activates GLUT1 via upregulating NF-κB in liver cancer
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  35. Prognostic significance of lymph node ratio in ovarian cancer
  36. Case Report
  37. Brainstem anaesthesia after retrobulbar block
  38. Review Article
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  44. Comparative study of back propagation artificial neural networks and logistic regression model in predicting poor prognosis after acute ischemic stroke
  45. Analysis of the factors affecting the prognosis of glioma patients
  46. Compare fuhrman nuclear and chromophobe tumor grade on chromophobe RCC
  47. Case Report
  48. Signet ring B cell lymphoma: A potential diagnostic pitfall
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  54. Management of complications of first instance of hepatic trauma in a liver surgery unit: Portal vein ligation as a conservative therapeutic strategy
  55. Matrix metalloproteinase 2 knockdown suppresses the proliferation of HepG2 and Huh7 cells and enhances the cisplatin effect
  56. Comparison of laparoscopy and open radical nephrectomy of renal cell cancer
  57. Case Report
  58. A severe complication of myocardial dysfunction post radiofrequency ablation treatment of huge hepatic hemangioma: a case report and literature review
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  63. Nasointestinal tube in mechanical ventilation patients is more advantageous
  64. The change of endotracheal tube cuff pressure during laparoscopic surgery
  65. Correlation between iPTH levels on the first postoperative day after total thyroidectomy and permanent hypoparathyroidism: our experience
  66. Case Report
  67. Primary angiosarcoma of the kidney: case report and comprehensive literature review
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  70. Incidental findings in dental radiology are concerning for family doctors
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  73. Indications and outcomes of splenectomy for hematological disorders
  74. Expression of CENPE and its prognostic role in non-small cell lung cancer
  75. Barbed suture and gastrointestinal surgery. A retrospective analysis
  76. Using post transplant 1 week Tc-99m DTPA renal scan as another method for predicting renal graft failure
  77. The pseudogene PTTG3P promotes cell migration and invasion in esophageal squamous cell carcinoma
  78. Lymph node ratio versus TNM system as prognostic factor in colorectal cancer staging. A single Center experience
  79. Review Article
  80. Minimally invasive pilonidal sinus treatment: A narrative review
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  82. Anatomical workspace study of Endonasal Endoscopic Transsphenoidal Approach
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  84. Communication
  85. Aspirin, a potential GLUT1 inhibitor in a vascular endothelial cell line
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  87. Osteopontin and fatty acid binding protein in ifosfamide-treated rats
  88. Familial polyposis coli: the management of desmoid tumor bleeding
  89. microRNA-27a-3p down-regulation inhibits malignant biological behaviors of ovarian cancer by targeting BTG1
  90. PYCR1 is associated with papillary renal cell carcinoma progression
  91. Prediction of recurrence-associated death from localized prostate cancer with a charlson comorbidity index–reinforced machine learning model
  92. Colorectal cancer in the elderly patient: the role of neo-adjuvant therapy
  93. Association between MTHFR genetic polymorphism and Parkinson’s disease susceptibility: a meta-analysis
  94. Metformin can alleviate the symptom of patient with diabetic nephropathy through reducing the serum level of Hcy and IL-33
  95. Case Report
  96. Severe craniofacial trauma after multiple pistol shots
  97. Research Article
  98. Echocardiography evaluation of left ventricular diastolic function in elderly women with metabolic syndrome
  99. Tailored surgery in inguinal hernia repair. The role of subarachnoid anesthesia: a retrospective study
  100. The factors affecting early death in newly diagnosed APL patients
  101. Review Article
  102. Oncological outcomes and quality of life after rectal cancer surgery
  103. Research Article
  104. MiR-638 repressed vascular smooth muscle cell glycolysis by targeting LDHA
  105. microRNA-16 via Twist1 inhibits EMT induced by PM2.5 exposure in human hepatocellular carcinoma
  106. Analyzing the semantic space of the Hippocratic Oath
  107. Fournier’s gangrene and intravenous drug abuse: an unusual case report and review of the literature
  108. Evaluation of surgical site infection in mini-invasive urological surgery
  109. Dihydromyricetin attenuates inflammation through TLR4/NF-kappaB pathway
  110. Clinico-pathological features of colon cancer patients undergoing emergency surgery: a comparison between elderly and non-elderly patients
  111. Case Report
  112. Appendix bleeding with painless bloody diarrhea: A case report and literature review
  113. Research Article
  114. Protective effects of specneuzhenide on renal injury in rats with diabetic nephropathy
  115. PBF, a proto-oncogene in esophageal carcinoma
  116. Use of rituximab in NHL malt type pregnant in I° trimester for two times
  117. Cancer- and non-cancer related chronic pain: from the physiopathological basics to management
  118. Case report
  119. Non-surgical removal of dens invaginatus in maxillary lateral incisor using CBCT: Two-year follow-up case report
  120. Research Article
  121. Risk factors and drug resistance of the MDR Acinetobacter baumannii in pneumonia patients in ICU
  122. Accuracy of tumor perfusion assessment in Rat C6 gliomas model with USPIO
  123. Lemann Index for Assessment of Crohn’s Disease: Correlation with the Quality of Life, Endoscopic Disease activity, Magnetic Resonance Index of Activity and C- Reactive Protein
  124. Case report
  125. Münchausen syndrome as an unusual cause of pseudo-resistant hypertension: a case report
  126. Research Article
  127. Renal artery embolization before radical nephrectomy for complex renal tumour: which are the true advantages?
  128. Prognostic significance of CD276 in non-small cell lung cancer
  129. Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit
  130. Effect of vitamin D3 on lung damage induced by cigarette smoke in mice
  131. CircRNA-UCK2 increased TET1 inhibits proliferation and invasion of prostate cancer cells via sponge miRNA-767-5p
  132. Case report
  133. Partial hydatidiform mole and coexistent live fetus: a case report and review of the literature
  134. Research Article
  135. Effect of NGR1 on the atopic dermatitis model and its mechanisms
  136. Clinical features of infertile men carrying a chromosome 9 translocation
  137. Review Article
  138. Expression and role of microRNA-663b in childhood acute lymphocytic leukemia and its mechanism
  139. Case Report
  140. Mature cystic teratoma of the pancreas: A rare cystic neoplasm
  141. Research Article
  142. Application of exercised-based pre-rehabilitation in perioperative period of patients with gastric cancer
  143. Case Report
  144. Predictive factors of intestinal necrosis in acute mesenteric ischemia
  145. Research Article
  146. Application of exercised-based pre-rehabilitation in perioperative period of patients with gastric cancer
  147. Effects of dexmedetomidine on the RhoA /ROCK/ Nox4 signaling pathway in renal fibrosis of diabetic rats
  148. MicroRNA-181a-5p regulates inflammatory response of macrophages in sepsis
  149. Intraventricular pressure in non-communicating hydrocephalus patients before endoscopic third ventriculostomy
  150. CyclinD1 is a new target gene of tumor suppressor miR-520e in breast cancer
  151. CHL1 and NrCAM are primarily expressed in low grade pediatric neuroblastoma
  152. Epidemiological characteristics of postoperative sepsis
  153. Association between unstable angina and CXCL17: a new potential biomarker
  154. Cardiac strains as a tool for optimization of cardiac resynchronization therapy in non-responders: a pilot study
  155. Case Report
  156. Resuscitation following a bupivacaine injection for a cervical paravertebral block
  157. Research Article
  158. CGF treatment of leg ulcers: A randomized controlled trial
  159. Surgical versus sequential hybrid treatment of carotid body tumors
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Heruntergeladen am 18.11.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2019-0052/html?lang=de
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