Robotic versus open salvage prostatectomy in recurrent disease: a systematic review and meta-analysis of surgical outcomes

The objective of this research was to evaluate the perioperative results, complications, and oncological outcomes associated with two distinct surgical methods for the treatment of recurrent prostate cancer: salvage robotic-assisted prostatectomy and salvage open prostatectomy. Our methodology concerned a complete search of major databases, along with PubMed, Web of Science, the Cochrane Library and Embase, covering studies published in all kinds of languages up to November 2024. Additionally, we omitted papers that included conference summaries and lacked relevance to our research. Various variables were assessed by employing weighted mean difference (WMD) and odds ratio (OR) metrics. The meta-analyses of the diverse parameters were carried out using Review Manager. Additionally, this study was registered with PROSPERO and the registration number is CRD42025632172. This meta-analysis encompassed three trials, comprising a total of 510 participants. The findings revealed that salvage robot-assisted prostatectomy (sRARP) had a longer operative time (WMD 13.88, 95% CI 3.94, 23.82; p = 0.006) and a lower rate of postoperative vesicourethral anastomotic stricture (OR 0.44, 95% CI 0.23-0.83; p = 0.01) compared to salvage open prostatectomy (sORP). However, no massive variations had been determined between the two surgical techniques regarding hospital stay, estimated blood loss, transfusion rate, complications, and oncological outcomes. In the context of recurrent prostate cancer, sRARP demonstrated superiority over sORP in reducing the rate of vesicourethral anastomotic stricture. Nonetheless, it is crucial to acknowledge that there were no significant disparities between the two techniques in terms of hospital stay, blood loss, transfusion requirements, complication rates, and oncological results. These insights suggest that robotic-assisted prostatectomy may offer certain advantages for patients undergoing salvage prostatectomy, but these benefits are not conclusive and warrant further validation through larger-scale, high-quality randomized controlled trials.