Systematic Review and Meta-analysis of Studies Reporting Oncologic Outcome After Robot-assisted Radical Prostatectomy

• Published in: European urology 2012-09, Vol.62 (3), p.382-404
• Main Authors: Novara, Giacomo, Ficarra, Vincenzo, Mocellin, Simone, Ahlering, Thomas E, Carroll, Peter R, Graefen, Markus, Guazzoni, Giorgio, Menon, Mani, Patel, Vipul R, Shariat, Shahrokh F, Tewari, Ashutosh K, Van Poppel, Hendrik, Zattoni, Filiberto, Montorsi, Francesco, Mottrie, Alexandre, Rosen, Raymond C, Wilson, Timothy G
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Chemotherapy, Adjuvant; Chi-Square Distribution; Disease-Free Survival; Evidence-Based Medicine; Gynecology. Andrology. Obstetrics; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - mortality; Lymph Node Excision; Male; Male genital diseases; Medical sciences; Multivariate Analysis; Nephrology. Urinary tract diseases; Odds Ratio; Proportional Hazards Models; Prostate-Specific Antigen - blood; Prostatectomy; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatectomy - mortality; Prostatic neoplasms; Prostatic Neoplasms - blood; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radiotherapy, Adjuvant; Risk Assessment; Risk Factors; Robotics; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - mortality; Survival Analysis; Time Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2012.05.047

Abstract Context Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited. Objective Evaluate lymph node yield, positive surgical margins (PSMs), use of adjuvant therapy, and biochemical recurrence (BCR)–free survival following RARP and perform a cumulative analysis of all studies comparing the oncologic outcomes of RARP and retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). Evidence acquisition A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK) and Stata 11.0 SE software (StataCorp, College Station, TX, USA). Evidence synthesis We retrieved 79 papers evaluating oncologic outcomes following RARP. The mean PSM rate was 15% in all comers and 9% in pathologically localized cancers, with some tumor characteristics being the most relevant predictors of PSMs. Several surgeon-related characteristics or procedure-related issues may play a major role in PSM rates. With regard to BCR, the very few papers with a follow-up duration >5 yr demonstrated 7-yr BCR-free survival estimates of approximately 80%. Finally, all the cumulative analyses comparing RARP with RRP and comparing RARP with LRP demonstrated similar overall PSM rates (RARP vs RRP: odds ratio [OR]: 1.21; p = 0.19; RARP vs LRP: OR: 1.12; p = 0.47), pT2 PSM rates (RARP vs RRP: OR: 1.25; p = 0.31; RARP vs LRP: OR: 0.99; p = 0.97), and BCR-free survival estimates (RARP vs RRP: hazard ratio [HR]: 0.9; p = 0.526; RARP vs LRP: HR: 0.5; p = 0.141), regardless of the surgical approach. Conclusions PSM rates are similar following RARP, RRP, and LRP. The few data available on BCR from high-volume centers are promising, but definitive comparisons with RRP or LRP are not currently possible. Finally, significant data on cancer-specific mortality are not currently available.