Kim Do Kyung, Moon Young Joon, Chung Doo Yong, Jung Hae Do, Jeon Seung Hyun, Kang Seok Ho, Paick Sunghyun, Lee Joo Yong
Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea.
Department of Urology, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea.
Medicina (Kaunas). 2025 Jan 2;61(1):61. doi: 10.3390/medicina61010061.
: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). : A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587-0.869) and LRP (RR 0.672, 95% CrI 0.505-0.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807-0.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997-1.124; RR 0.921, 95% CrI 0.845-1.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047-1.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047-1.402) and LRP (RR 1.438, 95% CrI 1.191-1.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. : RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications).
我们进行了一项系统评价和网状荟萃分析，以评估和比较机器人辅助根治性前列腺切除术（RARP）、腹腔镜根治性前列腺切除术（LRP）与开放性根治性前列腺切除术（ORP）在前列腺癌患者中的围手术期、功能和肿瘤学结局。在Pubmed、EMBASE和Cochrane图书馆中进行了全面的文献检索，以查找2021年5月之前发表的论文。仅纳入评估了围手术期、功能和肿瘤学结局并报告了结局值的前列腺癌患者研究。我们使用贝叶斯分层随机效应模型来综合多项研究的数据，从而能够对三种手术方法（RARP、LRP、ORP）进行直接和间接比较，以提供对它们相对疗效的可靠估计。该系统评价已在PROSPERO（CRD42021282555）中注册。本研究最终共纳入80项研究。RARP的生化复发（BCR）率低于ORP（RR 0.713，95% CrI 0.587 - 0.869）和LRP（RR 0.672，95% CrI 0.505 - 0.895）。与ORP相比，RARP的手术切缘阳性率显著更低（RR 0.893，95% CrI 0.807 - 0.985）。与ORP相比，RARP和LRP在控尿方面无显著差异（RR 1.057，95% CrI 0.997 - 1.124；RR 0.921，95% CrI 0.845 - 1.007）。与ORP相比，RARP在性功能恢复方面显著更有效（RR 1.201，95% CrI 1.047 - 1.402）。RARP的性功能恢复率显著高于ORP（RR 1.201，95% CrI 1.047 - 1.402）和LRP（RR 1.438，95% CrI 1.191 - 1.762）。RARP、ORP和LRP之间在估计失血量、总并发症率和主要并发症率方面无差异。LRP的手术时间最长。RARP和ORP之间的手术时间无差异。RARP在肿瘤学结局（手术切缘阳性和生化复发）、功能结局（性功能恢复和尿失禁）以及围手术期结局（估计失血量、手术时间、总并发症和主要并发症）方面可能优于或与ORP和LRP相当。
