Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and an meta-analysis update

CONTEXT: The safety and feasibility of robotic-assisted radical prostatectomy (RARP) compared with retropubic radical prostatectomy(RRP) is debated. Recently, a number of large-scale and high-quality studies have been conducted. OBJECTIVE: To obtain a more valid assessment, we update the meta-analysis of RARP compared with RRP to assessed its safety and feasibility in treatment of prostate cancer. METHODS: A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared RARP with RRP. Outcomes of interest included perioperative, pathologic variables and complications. RESULTS: 78 studies assessing RARP vs. RRP were included for meta-analysis. Although patients underwent RRP have shorter operative time than RARP (WMD: 39.85 minutes; P < 0.001), patients underwent RARP have less intraoperative blood loss (WMD = -507.67ml; P < 0.001), lower blood transfusion rates (OR = 0.13; P < 0.001), shorter time to remove catheter (WMD = -3.04day; P < 0.001), shorter hospital stay (WMD = -1.62day; P < 0.001), lower PSM rates (OR: 0.88; P = 0.04), fewer positive lymph nodes (OR: 0.45; P < 0.001), fewer overall complications (OR: 0.43; P < 0.001), higher 3-and 12-mo potent recovery rate (OR: 3.19; P = 0.02; OR: 2.37; P = 0.005, respectively), and lower readmission rate (OR: 0.70, P = 0.03). The biochemical recurrence free survival of RARP is better than RRP (OR: 1.33, P = 0.04). All the other calculated results are similar between the two groups. CONCLUSIONS: Our results indicate that RARP appears to be safe and effective to its counterpart RRP in selected patients.