title: Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer.
  
  
  METHODS
  Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies.
  
  
  RESULTS
  A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up.
  
  
  CONCLUSIONS
  RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP.
authors.affiliation: Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea.|Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Seo
authors.affiliation: Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.|Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea.
authors.forename: Na Rae
authors.initials: NR
authors.lastname: Lee
authors.affiliation: Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.|Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea.
authors.forename: Soo Kyung
authors.initials: SK
authors.lastname: Son
authors.affiliation: Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
authors.forename: Dae Keun
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. khrha@yuhs.ac.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea. sunarea87@gachon.ac.kr.
authors.forename: Seon Heui
authors.initials: SH
authors.lastname: Lee
mesh_terms: D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology
keywords: Prostatic neoplasms; meta-analysis; prostatectomy; robotics