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

University of Padua, Padua, Italy.
European Urology (Impact Factor: 13.94). 06/2012; 62(3):382-404. DOI: 10.1016/j.eururo.2012.05.047
Source: PubMed


Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited.
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).
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).
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.
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.

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Available from: Hendrik Paul Van Poppel, Nov 18, 2014
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    • "The publication by Hu et al can be seen as an example of small big data. Many publications have reported PSM after RP based on surgical approach [2] [3]; however, classical databases mostly include small and selected cohorts from centers of excellence. Analysis of a larger data set offers the ability to spot trends that better describe what happens in the real world. "
    European Urology 03/2015; 54(3). DOI:10.1016/j.eururo.2014.11.056 · 13.94 Impact Factor
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    • "Drawing on the current state of scientific evidence, the guidelines mention slightly reduced functional morbidities and complications after RARP, but " no difference " between the oncological results of RARP, ORP, and LRP (IKNL, 2013). The clinical superiority of RARP remains difficult to prove as the treatment outcome depends to a large extent on the surgeon's experience, the rate of learning robotic surgery skills, the hospital's surgical volume, and the patient's risk portfolio on cancer spread (Robertson et al., 2013; Novara et al., 2012). The Dutch guidelines conclude in the section 'Best therapy for localised prostate cancer' that the treatment results " depend mainly on the risk group and not on the method of treatment " (IKNL, 2013, p. 76). "
    Value in Health 11/2014; 17(7):A324. DOI:10.1016/j.jval.2014.08.571 · 3.28 Impact Factor
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    • "We applaud Karnes et al. [1] for their critique of our study that demonstrates fewer positive surgical margins and less additional cancer therapy within 2 yr for robot-assisted versus open radical prostatectomy [2]. They raise concerns about the validity of our study findings. "
    European Urology 03/2014; 66(4). DOI:10.1016/j.eururo.2014.03.012 · 13.94 Impact Factor
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