title: Perioperative, functional and oncological outcomes after open and minimally invasive prostate cancer surgery: experience from Australasia.
abstract: OBJECTIVE
  •  To systematically review the current literature concerning perioperative, functional and oncological outcomes reported after open and minimally invasive prostate cancer surgery specifically from institutions within Australasia.
  
  
  METHODS
  •  Four electronic databases were searched to identify studies reporting outcome after open and minimally invasive prostate cancer surgery. Studies were sought using the search term 'radical prostatectomy'. •  In all, 11,378 articles were retrieved. For the purpose of this review, data were only extracted from studies reporting Australasian experience. •  A total of 28 studies met final inclusion criteria.
  
  
  RESULTS
  •  Overall, the data are limited by the low methodological quality of available studies. •  Only two comparative studies evaluating open radical prostatectomy (ORP) and robotic-assisted laparoscopic RP (RALP) were identified, both non-randomized. •  The mean blood loss, catheterization time and hospital stay was shorter after RALP than with ORP. In contrast, mean operative procedure time was significantly longer for RALP. •  Overall adverse event rates were similar for the different surgical approaches although the rate of bladder neck stricture was significantly higher after open RP. •  Incorporation of patient outcomes achieved by surgeons still within their learning curve resulted in a trend towards higher positive surgical margin rates and lower continence scores after RALP. However, there was equivalence once the surgeons' learning curve was overcome. Given the limited follow-up for RALP and laparoscopic RP (14.7 and 6 months vs 43.8 months for ORP) and the lack of data concerning erectile function status, comparison of biochemical failure and potency was not possible.
  
  
  CONCLUSIONS
  •  Few comparative data are available from Australasia concerning open and minimally invasive prostate cancer surgery. •  While perioperative outcomes appear to favour minimally invasive approaches, further comparative assessment of functional and long-term oncological efficacy for the different surgical approaches is required to better define the role of minimally invasive approaches.
authors.affiliation: Department of Urology, Royal Melbourne Hospital, Melbourne, Australia. pjcathcart@hotmail.com
authors.forename: Paul
authors.initials: P
authors.lastname: Cathcart
authors.forename: Declan G
authors.initials: DG
authors.lastname: Murphy
authors.forename: Daniel
authors.initials: D
authors.lastname: Moon
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Costello
authors.forename: Mark
authors.initials: M
authors.lastname: Frydenberg
mesh_terms: D044362:Australasia; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011788:Quality of Life; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome