Department of Urology, Institute Mutualist Montsouris, Université Paris-Descartes, 42, Boulevard Joudan, 75674, Paris, France.
Division of Urology, University of Sao Paulo, Sao Paulo, Brazil.
World J Urol. 2017 Oct;35(10):1481-1488. doi: 10.1007/s00345-017-2021-9. Epub 2017 Feb 27.
To perform a meta-analysis comparing the rates of positive surgical margins (PSM) and biochemical recurrence (BCR) between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) in patients with high-risk prostate cancer.
A systematic review was performed on Pubmed, Embase and Scopus databases in August 2016, according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. References retrieved were evaluated using the Newcastle-Ottawa scale and the Black and Down's tool for quality assessment.
Nine retrospective cohorts comparing ORP and RARP were selected and included in the meta-analysis. All studies reported the PSMs. Patients treated with RARP presented less risk of PSMs (risk difference -0.04, p 0.02) than those treated with ORP. Five articles reported hazard ratios for BCR-free survival. Patients treated with RARP had less risk of BCR (HR 0.72, 95% CI 0.58-0.89) than those treated with ORP. Reports for PSM assessment were considered of adequate quality, while the studies retrieved for BCR assessment were considered limited because of the heterogeneity of their results.
Patients with high-risk prostate cancer treated with RARP have less risk of having PSM and BCR when compared to those treated with ORP. A strong conclusion is precluded due to the observational nature of the studies retrieved for our analysis.
对比较高风险前列腺癌患者行开放性前列腺根治术（ORP）和机器人辅助前列腺根治术（RARP）的阳性切缘（PSM）率和生化复发（BCR）率的研究进行荟萃分析。
2016 年 8 月，我们按照系统评价和荟萃分析的首选报告项目（PRISMA）声明，对 Pubmed、Embase 和 Scopus 数据库进行了系统回顾。使用纽卡斯尔-渥太华量表和 Black 和 Down 工具对检索到的参考文献进行了评估。
共选择了 9 项比较 ORP 和 RARP 的回顾性队列研究，并将其纳入荟萃分析。所有研究均报告了 PSM。与 ORP 相比，接受 RARP 治疗的患者发生 PSM 的风险较低（风险差-0.04，p<0.02）。有 5 篇文章报告了无 BCR 生存的危险比。与 ORP 相比，接受 RARP 治疗的患者发生 BCR 的风险较低（HR 0.72，95%CI 0.58-0.89）。关于 PSM 评估的报告被认为质量较高，而关于 BCR 评估的研究由于结果的异质性而被认为质量有限。
与接受 ORP 治疗的患者相比，接受 RARP 治疗的高风险前列腺癌患者发生 PSM 和 BCR 的风险较低。由于我们分析中检索到的研究是观察性研究，因此无法得出强有力的结论。
