title: Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy.
abstract: BACKGROUND
  Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited.
  
  
  OBJECTIVE
  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).
  
  
  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) and Stata 11.0 SE software (StataCorp, College Station, TX, USA).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: University of Padua, Padua, Italy. giacomo.novara@unipd.it
authors: Giacomo
authors: G
authors: Novara
authors: Vincenzo
authors: V
authors: Ficarra
authors: Simone
authors: S
authors: Mocellin
authors: Thomas E
authors: TE
authors: Ahlering
authors: Peter R
authors: PR
authors: Carroll
authors: Markus
authors: M
authors: Graefen
authors: Giorgio
authors: G
authors: Guazzoni
authors: Mani
authors: M
authors: Menon
authors: Vipul R
authors: VR
authors: Patel
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Ashutosh K
authors: AK
authors: Tewari
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: Raymond C
authors: RC
authors: Rosen
authors: Timothy G
authors: TG
authors: Wilson
mesh_terms: D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008197:Lymph Node Excision; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen