Ditonno Francesco, Pettenuzzo Greta, Montanaro Francesca, De Bon Lorenzo, Costantino Sonia, Toska Endri, Malandra Sarah, Cianflone Francesco, Bianchi Alberto, Porcaro Antonio Benito, Cerruto Maria Angela, Veccia Alessandro, Bertolo Riccardo, Antonelli Alessandro
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy.
Residency Program in Health Statistics and Biometrics, University of Verona, Verona, Italy.
Prostate Cancer Prostatic Dis. 2024 Oct 15. doi: 10.1038/s41391-024-00908-x.
We conducted a systematic review and meta-analysis of comparative studies to analyze intra- and postoperative outcomes of robot-assisted radical prostatectomy (RARP) using either DaVinci (DV-RARP) or Hugo™RAS (H-RARP) platforms.
The study was registered in PROSPERO (CRD42024562326) and followed PRISMA guidelines. Literature search was conducted in June 2024 using academic databases, focusing on articles from 2021 to 2024. Research question focused on men with PCa (P) undergoing H-RARP (I) versus DV-RARP (C) to evaluate surgical, pathology, and functional outcomes (O), across comparative studies. Continuous variables were summarized using mean difference (MD) and categorical variables using odds ratio with 95% confidence intervals (CI). Heterogeneity was assessed using Cochran's Q test and I statistics. Publication bias was evaluated with Egger's and Begg's tests. Statistical analysis was performed with Stata®17.0, with significance set at p < 0.05. Risk of bias was assessed using the ROBINS-I tool. Methodological quality was evaluated with AMSTAR 2.
Eight studies (three prospective, five retrospective) with 1114 patients (454 H-RARP vs. 660 DV-RARP) were included. Baseline characteristics were comparable between groups. No significant differences were found in overall operative time, console time, blood loss, nerve-sparing, or lymphadenectomy. Docking time was significantly longer for Hugo™RAS (MD:6 min,95% CI 4.2;7.8). Postoperative outcomes, including complications, length of stay, and catheterization time, were similar. Pathological outcomes showed no significant differences in positive surgical margins or staging, but lower node yield was observed with H-RARP (MD:-2,95% CI -3.3;-0.6). Urinary continence recovery was comparable. Risk of bias was moderate to serious.
The meta-analysis suggests H-RARP and DV-RARP perform not statistically different across most of analyzed outcomes, except for docking time and lymph-node yield. The longer docking time associated with the Hugo™RAS suggests demanding setup but does not translate into significantly longer operative time. Although statistically significant, the observed difference in lymph-node yield might be clinically negligible.
我们对比较研究进行了系统评价和荟萃分析，以分析使用达芬奇（DV-RARP）或Hugo™RAS（H-RARP）平台进行机器人辅助根治性前列腺切除术（RARP）的术中和术后结果。
该研究在PROSPERO（CRD42024562326）注册，并遵循PRISMA指南。2024年6月使用学术数据库进行文献检索，重点关注2021年至2024年的文章。研究问题聚焦于接受H-RARP（I）与DV-RARP（C）的前列腺癌（P）男性患者，以评估比较研究中的手术、病理和功能结果（O）。连续变量使用平均差（MD）进行汇总，分类变量使用95%置信区间（CI）的比值比进行汇总。使用Cochran's Q检验和I统计量评估异质性。使用Egger's检验和Begg's检验评估发表偏倚。使用Stata®17.0进行统计分析，显著性设定为p < 0.05。使用ROBINS-I工具评估偏倚风险。使用AMSTAR 2评估方法学质量。
纳入了八项研究（三项前瞻性研究，五项回顾性研究），共1114例患者（454例H-RARP vs. 660例DV-RARP）。两组之间的基线特征具有可比性。在总手术时间、控制台时间、失血量、神经保留或淋巴结清扫方面未发现显著差异。Hugo™RAS的对接时间明显更长（MD：6分钟，95% CI 4.2；7.8）。术后结果，包括并发症、住院时间和导尿时间，相似。病理结果显示手术切缘阳性或分期无显著差异，但H-RARP的淋巴结检出率较低（MD：-2，95% CI -3.3；-0.6）。尿失禁恢复情况相当。偏倚风险为中度至重度。
荟萃分析表明，除对接时间和淋巴结检出率外，H-RARP和DV-RARP在大多数分析结果上无统计学差异。与Hugo™RAS相关的对接时间较长表明设置要求较高，但并未转化为明显更长的手术时间。尽管在统计学上有显著差异，但观察到的淋巴结检出率差异在临床上可能微不足道。
