Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China.
J Robot Surg. 2023 Dec;17(6):2617-2631. doi: 10.1007/s11701-023-01714-8. Epub 2023 Sep 18.
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
本研究旨在综合所有现有前瞻性比较研究，并报告最新的系统分析和更新的证据，比较机器人辅助根治性前列腺切除术（RARP）与开放性根治性前列腺切除术（ORP）在围手术期、功能和肿瘤学结局方面对临床局限性前列腺癌（PCa）患者的影响。检索了 PubMed、Embase、Web of Science 和 Cochrane Library 截至 2023 年 3 月的数据。仅纳入随机对照试验（RCT）和前瞻性比较研究，并使用加权均数差（WMD）和比值比（OR）评估汇总结果。本 meta 分析共纳入 21 篇文章。结果表明，与 ORP 相比，RARP 手术时间更长（WMD：51.41 分钟；95%CI：28.33，74.48；p<0.0001），术中出血量更少（WMD：-516.59 毫升；95%CI：-578.31，-454.88；p<0.00001），输血率更低（OR：0.23；95%CI：0.18，0.30；p<0.00001），住院时间更短（WMD：-1.59 天；95%CI：-2.69，-0.49；p=0.005），总并发症更少（OR：0.61；95%CI：0.45，0.83；p=0.001），神经保留率更高（OR：1.64；95%CI：1.26，2.13；p=0.0003），且术后勃起功能恢复和生化复发（BCR）更有利。然而，两组主要并发症、术后尿控恢复或阳性切缘（PSM）率无显著差异。在住院时间、术中出血量、输血率、并发症、神经保留、术后勃起功能恢复和 BCR 方面，RARP 优于 ORP。RARP 是治疗临床局限性 PCa 的一种安全有效的手术方法。
