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Ma J, Xu W, Chen R, Zhu Y, Wang Y, Cao W, Ju G, Ren J, Ye X, He Q, Chang Y, Ren S. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies. Int J Surg 2023; 109:1350-1359. [PMID: 37070788 PMCID: PMC10389430 DOI: 10.1097/js9.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/30/2022] [Indexed: 04/19/2023]
Abstract
BACKGROUND Due to the lack of sufficient evidence, it is not clear whether robotic-assisted radical prostatectomy (RARP) or laparoscopic radical prostatectomy (LRP) is better for prostate cancer. The authors conducted this study by separately pooling and analysing randomised controlled trials (RCTs) and non-randomised studies to compare the perioperative, functional, and oncologic outcomes between RARP and LRP. METHODS A systematic literature search was performed in March 2022 using Cochrane Library, Pubmed, Embase, Medline, Web of Science, and China National Knowledge Infrastructure. Two independent reviewers performed literature screening, data extraction and quality assessment according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Subgroup analysis and sensitivity analysis were performed. RESULTS A total of 46 articles were included, including 4 from 3 RCTs and 42 from non-randomised studies. For RCTs, meta-analysis showed that RARP and LRP were similar in blood loss, catheter indwelling time, overall complication rate, overall positive surgical margin and biochemical recurrence rates, but quantitative synthesis of non-randomised studies showed that RARP was associated with less blood loss [weighted mean difference (WMD)=-71.99, 95% CI -99.37 to -44.61, P <0.001], shorter catheterization duration (WMD=-1.03, 95% CI -1.84 to -0.22, P =0.010), shorter hospital stay (WMD=-0.41, 95% CI -0.68 to -0.13, P =0.004), lower transfusion rate (OR=0.44, 95% CI 0.35-0.56, P <0.001), lower overall complication rate (OR=0.72, 95% CI 0.54-0.96, P =0.020), and lower biochemical recurrence rate (OR=0.78, 95% CI 0.66-0.92, P =0.004), compared with LRP. Both meta-analysis of RCTs and quantitative synthesis of non-randomised studies showed that RARP was associated with improved functional outcomes. From the results of the meta-analysis of RCTs, RARP was higher than LRP in terms of overall continence recovery [odds ratio (OR)=1.60, 95% CI 1.16-2.20, P =0.004), overall erectile function recovery (OR=4.07, 95% CI 2.51-6.60, P <0.001), continence recovery at 1 month (OR=2.14, 95% CI 1.25-3.66, P =0.005), 3 (OR=1.51, 95% CI 1.12-2.02, P =0.006), 6 (OR=2.66, 95% CI 1.31-5.40, P =0.007), and 12 months (OR=3.52, 95% CI 1.36-9.13, P =0.010) postoperatively, and potency recovery at 3 (OR=4.25, 95% CI 1.67-10.82, P =0.002), 6 (OR=3.52, 95% CI 1.31-9.44, P =0.010), and 12 months (OR=3.59, 95% CI 1.78-7.27, P <0.001) postoperatively, which were consistent with the quantitative synthesis of non-randomised studies. When sensitivity analysis was performed, the results remained largely unchanged, but the heterogeneity among studies was greatly reduced. CONCLUSION This study suggests that RARP can improve functional outcomes compared with LRP. Meanwhile, RARP has potential advantages in perioperative and oncologic outcomes.
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Affiliation(s)
| | - Weidong Xu
- Department of Urology, Changzheng Hospital
| | - Rui Chen
- Department of Urology, Changhai Hospital
| | | | - Ye Wang
- Department of Urology, Changhai Hospital
| | - Wanli Cao
- Department of Urology, Changzheng Hospital
| | - Guanqun Ju
- Department of Urology, Changzheng Hospital
| | | | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Qian He
- Department of Health Statistics, Naval Medical University, Shanghai, China
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Lee SH, Seo HJ, Lee NR, Son SK, Kim DK, Rha KH. Robot-assisted radical prostatectomy has lower biochemical recurrence than laparoscopic radical prostatectomy: Systematic review and meta-analysis. Investig Clin Urol 2017; 58:152-163. [PMID: 28480340 PMCID: PMC5419109 DOI: 10.4111/icu.2017.58.3.152] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the effectiveness and safety of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer. Materials and Methods Existing systematic reviews were updated to investigate the effectiveness and safety of RARP. Electronic databases, including Ovid MEDLINE, Ovid Embase, the Cochrane Library, KoreaMed, Kmbase, and others, were searched through July 2014. The quality of the selected systematic reviews was assessed by using the revised assessment of multiple systematic reviews (R-Amstar) and the Cochrane Risk of Bias tool. Meta-analysis was performed by using Revman 5.2 (Cochrane Community) and Comprehensive Meta-Analysis 2.0 (CMA; Biostat). Cochrane Q and I2 statistics were used to assess heterogeneity. Results Two systematic reviews and 16 additional studies were selected from a search performed of existing systematic reviews. These included 2 randomized controlled clinical trials and 28 nonrandomized comparative studies. The risk of complications, such as injury to organs by the Clavien-Dindo classification, was lower with RARP than with LRP (relative risk [RR], 0.44; 95% confidence interval [CI], 1.23–0.85; p=0.01). The risk of urinary incontinence was lower (RR, 0.43; 95% CI, 0.31–0.60; p<0.000001) and the potency rate was significantly higher with RARP than with LRP (RR, 1.38; 95% CI, 1.11–1.70; I2=78%; p=0.003). Regarding positive surgical margins, no significant difference in risk between the 2 groups was observed; however, the biochemical recurrence rate was lower after RARP than after LRP (RR, 0.59; 95% CI, 0.48–0.73; I2=21%; p<0.00001). Conclusions RARP appears to be a safe and effective technique compared with LRP with a lower complication rate, better potency, a higher continence rate, and a decreased rate of biochemical recurrence.
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Affiliation(s)
- Seon Heui Lee
- Department of Nursing Science, Gachon University College of Nursing, Incheon, Korea
| | - Hyun Ju Seo
- Department of Nursing, Chosun University College of Medicine, Gwangju, Korea
| | - Na Rae Lee
- Department of Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Soo Kyung Son
- Department of Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Seoul Station Medical Center, CHA University, CHA Medical School, Seoul, Korea.,Department of Urology, Hanyang University School of Medicine, Graduate School, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A. Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc 2016; 30:4330-52. [PMID: 26895896 PMCID: PMC5009165 DOI: 10.1007/s00464-016-4752-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/11/2016] [Indexed: 12/14/2022]
Abstract
Background Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures. Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov were searched from 1990 up to October 2013 with no language restriction. Relevant review articles were hand-searched for remaining studies. Randomised controlled trials (RCTs) and prospective comparative studies (PROs) on perioperative outcomes, regardless of patient age and sex, were included. Primary outcomes were blood loss, blood transfusion rate, operative time, length of hospital stay, and 30-day overall complication rate. Results We identified 99 relevant articles (108 studies, 14,448 patients). For robotic versus OS, 50 studies (11 RCTs, 39 PROs) demonstrated reduction in blood loss [ratio of means (RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602], transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449], length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day overall complication rate (RR 0.637, 0.483–0.838) in favour of robotic surgery. For robotic versus MIS, 58 studies (21 RCTs, 37 PROs) demonstrated reduced blood loss (RoM 0.853, 0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in favour of robotic surgery but similar length of hospital stay (RoM 0.982, 0.936–1.027) and 30-day overall complication rate (RR 0.988, 0.822–1.188). In both comparisons, robotic surgery prolonged operative time (OS: RoM 1.073, 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of robotic surgery lacked robustness on RCT-sensitivity analyses. However, many studies, including the relatively few available RCTs, suffered from high risk of bias and inadequate statistical power. Conclusions Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming. Better quality evidence is needed to guide surgical decision making regarding the precise clinical targets of this innovation in the next generation of its use.
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Affiliation(s)
- Alan Tan
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK.
| | - Alasdair J Scott
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Sam E Mason
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, London, SW7 2NA, UK
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Ku JY, Ha HK. Learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy. World J Mens Health 2015; 33:30-5. [PMID: 25927060 PMCID: PMC4412005 DOI: 10.5534/wjmh.2015.33.1.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 12/31/2014] [Accepted: 01/10/2015] [Indexed: 11/15/2022] Open
Abstract
Purpose Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. Materials and Methods A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Results Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 minutes and 118.1±39.1 minutes, and 6.4±0.9 days and 6.6±1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). Conclusions Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Busan, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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[Erectile function and sexuality of partners after radical prostatectomy with robotics versus manual laparoscopy: long-term assessment]. Prog Urol 2013; 23:42-9. [PMID: 23287483 DOI: 10.1016/j.purol.2012.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 08/05/2012] [Accepted: 09/09/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the long-term sexual outcome of laparoscopic radical prostatectomy (LRP) vs robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS A questionnaire was sent to the 412 patients treated by the same surgeon by LRP or RALP from March 2004 to July 2009. Ninety-six patients were evaluated preoperatively with a good erectile function before surgery and a follow-up more than 24 months. Erectile function was evaluated by the IIEF-5, the QLQ-C30 PR25 questionnaires. Partner's sexuality was evaluated with a FSFI's based questionnaire. RESULTS There was no significant difference before surgery between two groups LRP and RALP. After surgery, the IIEF-5 without any treatment was better in RALP group than in LRP group (P=0.025). When a bilateral nerve sparing was performed, the IIEF-5 maximum was better in RALP group (P=0.002). For the partners, there was no difference between the two techniques and it appeared that communication about sexuality is the less altered, long time after a radical prostatectomy. CONCLUSIONS In case of bilateral nerve sparing prostatectomy, an experimented operator in laparoscopic surgery should have better long-term erectile function results with RALP than LRP. Partner's sexuality modifications need more prospective studies to know its influence on erectile rehabilitation.
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Erauso A, Perrouin-Verbe MA, Papin G, Volant A, Doucet L, Joulin V, Deruelle C, Rousseau B, Valeri A, Fournier G. [Urinary continence following laparoscopic radical prostatectomy: qualitative analysis]. Prog Urol 2012; 22:945-53. [PMID: 23102017 DOI: 10.1016/j.purol.2012.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The main purpose of this study was to report urinary continence after laparoscopic radical prostatectomy (LRP) for localised prostate cancer and the return to baseline rate for urinary continence. The minor purpose was to determine the risk factors, which influence return to baseline urinary continence after radical prostatectomy. METHODS Prospective evaluation of urinary continence with self-administered questionnaire in 300 consecutive LRP for localized prostate cancer. RESULTS After LRP, at 3, 6 and 12 months, respectively 12.5%, 23% and 33.7% of patients recover baseline urinary continence. Fifty-four percent, 72.3% and 78.4% of patients did not wear pads 3, 6 and 12 months after LRP. In patients without pad, 43 % recovered baseline continence one year after radical prostatectomy. In univariate analysis, age older than 60 years (P=0.003, P=0.003, P=0.02, 3, 6 and 12 months after LRP) and no sparing of neurovascular bundles (P=0.01, P=0.08 at 3 and 6 months after LRP) were risks factors of urinary incontinence. In multivariate analysis, only age older than 60 years (P=0.018, P=0.01 and P=0.01 at 3, 6 and 12 months after LRP) was a risk factor of urinary incontinence. CONCLUSION One year after LRP, 66.3% of patients had urinary incontinence according to our evaluation using stringent criteria, i.e. return to baseline continence status. However, only 21.6% of patients wore pads and less than 2% wore more than two pads per day.
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Affiliation(s)
- A Erauso
- Service d'urologie, hôpital de la Cavale Blanche, CHRU de Brest, Brest, France.
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Koutlidis N, Mourey E, Champigneulle J, Mangin P, Cormier L. Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience. Int J Urol 2012; 19:1076-81. [DOI: 10.1111/j.1442-2042.2012.03102.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[Urinary continence following radical prostatectomy: comparison of open, laparoscopic, and robotic approaches]. Presse Med 2011; 40:e477-82. [PMID: 21601413 DOI: 10.1016/j.lpm.2011.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 02/22/2011] [Indexed: 11/23/2022] Open
Abstract
AIM To compare urinary continence following radical prostatectomy (RP) between open (Op), laparoscopic (Lap), and robotic (Ro) approaches. METHOD Urinary continence of the first 59 patients operated by Ro RP between May 2008 and August 2009 was evaluated by self-questionnaires. Results were compared to those obtained in 2006 using the same questionnaire from patients operated by Lap RP or Op RP in the same institution. Patients treated by radiotherapy were excluded from the analysis. RESULTS Fifty-one of the 59 operated by RP Ro answered the questionnaire. Op and Lap groups included 82 and 100 patients respectively. No significant difference was observed between the three groups in terms of age, body mass index, preoperative PSA, prostate gland weight, and TNM stage on pathology. Overall incontinence rate was 8%, 32%, and 21% for Ro, Lap, and Op RP, respectively. Median duration to recover continence after surgery was three weeks in the Ro group, versus eight weeks in the two other groups. CONCLUSION In our experience, patients operated by a Ro approach had a lower risk of incontinence and a shorter duration to recover continence compared to those operated by Op and Lap RP. Our previous experience of laparoscopy might explain these findings. Evaluation of overall functional and oncological results is necessary before concluding to a possible superiority of Ro RP.
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Ferronha F, Barros F, Santos VV, Ravery V, Delmas V. Is there any evidence of superiority between retropubic, laparoscopic or robot-assisted radical prostatectomy? Int Braz J Urol 2011; 37:146-58; discussion 159-60. [DOI: 10.1590/s1677-55382011000200002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2010] [Indexed: 11/22/2022] Open
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Kermarrec I, Mangin P, Koutlidis N, Mourey E, Cormier L. [Does robotics improve laparoscopic radical prostatectomy in complex surgical cases?]. Prog Urol 2010; 20:638-43. [PMID: 20951932 DOI: 10.1016/j.purol.2010.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 02/28/2010] [Accepted: 03/17/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED The radical prostatectomy is the main treatment prostate cancer in young men. However in difficult cases, another therapeutic option is often suggested. OBJECTIVE Evaluation of the quality of the anastomosis in complex surgical cases by comparing laparoscopic radical prostatectomy (LRP) to robotic assisted radical prostatectomy (RLRP). MATERIAL From March 2004 to August 2009, 397 patients underwent radical prostatectomy: 176 LRP and 221 RLRP consecutively by the same surgeon. Antecedents that might have complicated dissection were analyzed: prostatic volume over 80 cc, previous inguinal hernia repair with mesh, previous pelvic surgery, body mass index over 30 and previous trans-urethral resection of prostate. RESULTS In a preoperative mode, there was no significant difference between the two groups. A multivariable analysis of the quality of the anastomosis turned to the advantage of the robot (OR=2.56 [95 %CI: 1.28-5.25]), specifically for difficult cases (Odd Ratio=7.736 [95 %CI: 2.689-22.254]). CONCLUSION The use of the robot improved the quality of the anastomosis for patients that might have raised technical issues.
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Affiliation(s)
- I Kermarrec
- Service d'urologie, hôpital Bocage, faculté de médecine de Dijon, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
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[Are the rules of "evidence based medicine" strictly followed in the field of robot-assisted laparoscopic radical prostatectomy?]. Prog Urol 2010; 20:596-7. [PMID: 20832038 DOI: 10.1016/j.purol.2009.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 12/15/2009] [Indexed: 11/20/2022]
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Bastide C, Rozet F, Salomon L, Mongiat-Artus P, Beuzeboc P, Cormier L, Eiss D, Gaschignard N, Peyromaure M, Richaud P, Soulié M. [Critic analysis of a comparative meta-analysis on the morbidity, functional and carcinologic results after radical prostatectomy according to surgical approach. Work of cancerology committee of the French urological association]. Prog Urol 2010; 20:547-52. [PMID: 20832030 DOI: 10.1016/j.purol.2010.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 04/15/2010] [Accepted: 04/27/2010] [Indexed: 11/15/2022]
Abstract
Surgical approach for radical prostatectomy is even today a subject of debate in the urologic community. Many comparative studies between retropubic and laparoscopic approach (robotic assisted or not) were reported since 10 years without being able to decide between the supporters of retropubic or laparoscopic approach. The committee of cancer research of the French urological association took hold this question after a recent meta-analysis publication on this subject. Although imperfect, this meta-analysis exists and permits to conclude partially on the advantages and the inconveniences supposed for each surgical approach. Regarding morbidity after radical prostatectomy, the only significant difference reported concerns the hemorrhagic risk in favour of the laparoscopic approach. Regarding oncologic results, the only exploitable data concern positive surgical margins rate, which is identical whatever surgical approach. Concerning the functional results, no difference was reported in the literature between different surgical approaches.
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Affiliation(s)
- C Bastide
- Service d'urologie, hôpital Nord, pavillon l'étoile, chemin des Bourrely, 13015 Marseille, France.
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