Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies.
BACKGROUND
Despite the wide diffusion of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), only few studies comparing the results of these techniques with the retropubic radical prostatectomy (RRP) are currently available.


OBJECTIVE
To evaluate the perioperative, functional, and oncologic results in the comparative studies evaluating RRP, LRP, and RALP.


METHODS
A systematic review of the literature was performed in January 2008, searching Medline, Embase, and Web of Science databases. A "free-text" protocol using the term radical prostatectomy was applied. Some 4000 records were retrieved from the Medline database; 2265 records were retrieved from the Embase database;, and 4219 records were retrieved from the Web of Science database. Three of the authors reviewed the records to identify comparative studies. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK).


RESULTS
Thirty-seven comparative studies were identified in the literature search, including a single, randomised, controlled trial. With regard to the perioperative outcome, LRP and RALP were more time consuming than RRP, especially in the initial steps of the learning curve, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates all favoured LRP. With regard to the functional results, LRP and RRP showed similar continence and potency rates. Similarly, no significant differences were identified between LRP and RALP, while a single, nonrandomised, prospective study suggested advantages in terms of both continence and potency recovery after RALP, compared with RRP. With regard to the oncologic outcome, LRP and RALP were associated with positive surgical margin rates similar to those of RRP.


CONCLUSIONS
The quality of the available comparative studies was not excellent. LRP and RALP are followed by significantly lower blood loss and transfusion rates, but the available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. Further high-quality, prospective, multicentre, comparative studies are needed.
Ficarra
Vincenzo
V
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy. vincenzo.ficarra@unipd.it
Novara
Giacomo
G
Artibani
Walter
W
Cestari
Andrea
A
Galfano
Antonio
A
Graefen
Markus
M
Guazzoni
Giorgio
G
Guillonneau
Bertrand
B
Menon
Mani
M
Montorsi
Francesco
F
Patel
Vipul
V
Rassweiler
Jens
J
Van Poppel
Hendrik
H
D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D018570:Risk Assessment; D012371:Robotics; D015996:Survival Rate; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods