title: Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy.
abstract: BACKGROUND
  Perioperative complications are a major surgical outcome for radical prostatectomy (RP).
  
  
  OBJECTIVE
  Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications.
  
  
  METHODS
  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).
  
  
  RESULTS
  We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p<0.00001) and transfusion rate (odds ratio [OR]: 7.55; p<0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p=0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach.
  
  
  CONCLUSIONS
  RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach.
authors: University of Padua, Padua, Italy. giacomo.novara@unipd.it
authors: Giacomo
authors: G
authors: Novara
authors: Vincenzo
authors: V
authors: Ficarra
authors: Raymond C
authors: RC
authors: Rosen
authors: Walter
authors: W
authors: Artibani
authors: Anthony
authors: A
authors: Costello
authors: James A
authors: JA
authors: Eastham
authors: Markus
authors: M
authors: Graefen
authors: Giorgio
authors: G
authors: Guazzoni
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Jens-Uwe
authors: JU
authors: Stolzenburg
authors: Hendrik
authors: H
authors: Van Poppel
authors: Filiberto
authors: F
authors: Zattoni
authors: Francesco
authors: F
authors: Montorsi
authors: Alexandre
authors: A
authors: Mottrie
authors: Timothy G
authors: TG
authors: Wilson
mesh_terms: D016009:Chi-Square Distribution; D019317:Evidence-Based Medicine; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome