Advertisement

World Journal of Urology

, Volume 36, Issue 4, pp 609–621 | Cite as

Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?

  • Abbas Basiri
  • Jean JMCH de la Rosette
  • Shahin Tabatabaei
  • Henry H. Woo
  • M. Pilar Laguna
  • Hamidreza Shemshaki
Review

Abstract

Purpose

This study is a systematic analysis of the evidence regarding oncological, perioperative and postoperative outcomes and the cost of open retropubic radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP).

Methods

Summary data was abstracted from 104 original research articles representing 227,400 patients. PubMed/Medline, Scopus, Google Scholar, EMBASE and the Cochrane Library were reviewed in December 2016. A total of 104 publications were selected for inclusion. The primary outcomes were positive surgical margin (PSM) and major complication rate according to Clavien classifications. Secondary outcomes were operative time, length of hospital stay, estimated blood loss, transfusions, conversions, rate of post-operative erectile dysfunction and incontinence and total cost of procedure.

Results

ORP had a significantly higher rate than RALP for PSM (OR: 1.18; 95% CI 1.05–1.32; p = 0.004), but the rate of PSM was not significantly different between ORP versus LRP (OR: 1.37; 95% CI 0.88–2.14; p = 0.17) and RALP versus LRP (OR: 0.83; 95% CI 0.40–1.72; p = 0.62). The major Clavien complication rate was significantly different between ORP and RALP (OR: 2.14; 95% CI 1.24–3.68; p = 0.006). Estimated blood loss, transfusions and length of hospital stay were low for RALP, moderate for LRP and high for ORP. The rate of erectile dysfunction (OR: 2.58; 95% CI 1.77–3.75; p < 0.001) and incontinence (OR: 3.57; 95% CI 2.28–5.58; p < 0.001) were significantly lower after RALP than LRP and equivalent for other comparisons. Total cost was highest for RALP, followed by LRP and ORP.

Conclusions

For PSM and peri- and post-operative complications, RALP showed better results than ORP and LRP. In the context of the biases between the studies, one should interpret the results with caution.

Keywords

Robotics Laparoscopy Retropubic Prostatectomy Complications Prostate cancer Margins 

Notes

Author contributions

AB: Protocol/project development; data collection or management. JJR: protocol/project development; data collection or management. ST: protocol/project development; data collection or management, manuscript writing/editing. HHW: manuscript writing/editing, data analysis. MPL: manuscript writing/editing, data analysis. HS: protocol/project development; data collection or management, manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

No conflict of interest existed.

Research involving human participants and/or animals

The data was gathered as systematic review and no human/animal was involved.

Informed consent

The data was gathered as systematic review and no human/animal was involved.

Supplementary material

345_2018_2174_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)
345_2018_2174_MOESM2_ESM.docx (60 kb)
Supplementary material 2 (DOCX 59 kb)
345_2018_2174_MOESM3_ESM.jpg (82 kb)
Distribution of included studies over time (JPEG 81 kb)
345_2018_2174_MOESM4_ESM.png (25 kb)
Forest plot of included studies which comparing major complication rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 24 kb)
345_2018_2174_MOESM5_ESM.png (43 kb)
Forest plot of included studies which comparing operative time in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 43 kb)
345_2018_2174_MOESM6_ESM.png (40 kb)
Forest plot of included studies which comparing length of hospital stay in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 39 kb)
345_2018_2174_MOESM7_ESM.png (37 kb)
Forest plot of included studies which comparing estimated blood loss in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 37 kb)
345_2018_2174_MOESM8_ESM.png (44 kb)
Forest plot of included studies which comparing transfusion rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 43 kb)
345_2018_2174_MOESM9_ESM.png (21 kb)
Forest plot of included studies which comparing erectile dysfunction rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 20 kb)
345_2018_2174_MOESM10_ESM.png (22 kb)
Forest plot of included studies which comparing incontinency rate in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 22 kb)
345_2018_2174_MOESM11_ESM.png (17 kb)
Forest plot of included studies which comparing total cost in open versus robotic-assisted laparoscopic radical prostatectomy (PNG 16 kb)
345_2018_2174_MOESM12_ESM.png (172 kb)
Difference of stage by stage prostate cancer among the studies (PNG 171 kb)
345_2018_2174_MOESM13_ESM.docx (19 kb)
Supplementary material 13 (DOCX 19 kb)

References

  1. 1.
    Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T et al (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62(4):220–241PubMedCrossRefGoogle Scholar
  2. 2.
    Eggleston JC, Walsh PC (1985) Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases. J Urol 134(6):1146–1148PubMedCrossRefGoogle Scholar
  3. 3.
    Lein M, Stibane I, Mansour R, Hege C, Roigas J, Wille A et al (2006) Complications, urinary continence, and oncologic outcome of 1000 laparoscopic transperitoneal radical prostatectomies-experience at the Charite Hospital Berlin. Campus Mitte. Eur Urol. 50(6):1278–1282 (discussion 83–4) PubMedCrossRefGoogle Scholar
  4. 4.
    Boccon-Gibod L (2006) Radical prostatectomy: open? laparoscopic? robotic? Eur Urol 49(4):598–599PubMedCrossRefGoogle Scholar
  5. 5.
    Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T (2003) Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol 169(5):1689–1693PubMedCrossRefGoogle Scholar
  6. 6.
    Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M et al (2012) Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 62(3):382–404PubMedCrossRefGoogle Scholar
  7. 7.
    Kim SP, Boorjian SA, Shah ND, Weight CJ, Tilburt JC, Han LC et al (2013) Disparities in access to hospitals with robotic surgery for patients with prostate cancer undergoing radical prostatectomy. J Urol 189(2):514–520PubMedCrossRefGoogle Scholar
  8. 8.
    Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M et al (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55(5):1037–1063PubMedCrossRefGoogle Scholar
  9. 9.
    Parsons JK, Bennett JL (2008) Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology 72(2):412–416PubMedCrossRefGoogle Scholar
  10. 10.
    Ficarra V, Cavalleri S, Novara G, Aragona M, Artibani W (2007) Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol 51(1):45–55 (discussion 6) PubMedCrossRefGoogle Scholar
  11. 11.
    Artibani W, Ficarra V, Guillonneau BD (2007) Open to debate. The motion: a robot is needed to perform the best nerve sparing prostatectomy. Eur Urol 52(1):275–278PubMedCrossRefGoogle Scholar
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L et al (2016) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 388(10049):1057–1066PubMedCrossRefGoogle Scholar
  15. 15.
    Ghavamian R, Knoll A, Boczko J, Melman A (2006) Comparison of operative and functional outcomes of laparoscopic radical prostatectomy and radical retropubic prostatectomy: single surgeon experience. Urology. 67(6):1241–1246PubMedCrossRefGoogle Scholar
  16. 16.
    Guazzoni G, Cestari A, Naspro R, Riva M, Centemero A, Zanoni M et al (2006) Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomised, single-surgeon study. Eur Urol 50(1):98–104PubMedCrossRefGoogle Scholar
  17. 17.
    Poulakis V, Witzsch U, de Vries R, Dillenburg W, Becht E (2007) Laparoscopic radical prostatectomy in men older than 70 years of age with localized prostate cancer: comparison of morbidity, reconvalescence, and short-term clinical outcomes between younger and older men. Eur Urol 51(5):1341–1348 (discussion 9) PubMedCrossRefGoogle Scholar
  18. 18.
    Wagner AA, Link RE, Trock BJ, Sullivan W, Pavlovich CP (2007) Comparison of open and laparoscopic radical prostatectomy outcomes from a surgeon’s early experience. Urology 70(4):667–671PubMedCrossRefGoogle Scholar
  19. 19.
    Drouin SJ, Vaessen C, Hupertan V, Comperat E, Misrai V, Haertig A et al (2009) Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol 27(5):599–605PubMedCrossRefGoogle Scholar
  20. 20.
    Dahl DM, Barry MJ, McGovern FJ, Chang Y, Walker-Corkery E, McDougal WS (2009) A prospective study of symptom distress and return to baseline function after open versus laparoscopic radical prostatectomy. J Urol 182(3):956–965PubMedCrossRefGoogle Scholar
  21. 21.
    Louie-Johnsun MW, Handmer MM, Calopedos RJ, Chabert C, Cohen RJ, Gianduzzo TR et al (2016) The Australian laparoscopic non robotic radical prostatectomy experience–analysis of 2943 cases (USANZ supplement). BJU Int. 118(Suppl 3):43–48PubMedCrossRefGoogle Scholar
  22. 22.
    Artibani W, Grosso G, Novara G, Pecoraro G, Sidoti O, Sarti A et al (2003) Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy. Eur Urol 44(4):401–406PubMedCrossRefGoogle Scholar
  23. 23.
    Remzi M, Klingler HC, Tinzl MV, Fong YK, Lodde M, Kiss B et al (2005) Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy versus open retropubic radical prostatectomy. Eur Urol 48(1):83–89 (discussion 9) PubMedCrossRefGoogle Scholar
  24. 24.
    Roumeguere T, Bollens R, Vanden Bossche M, Rochet D, Bialek D, Hoffman P et al (2003) Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol 20(6):360–366PubMedGoogle Scholar
  25. 25.
    Greco F, Wagner S, Hoda MR, Kawan F, Inferrera A, Lupo A et al (2010) Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients. BJU Int 106(4):543–547PubMedCrossRefGoogle Scholar
  26. 26.
    Al-Shaiji TF, Kanaroglou N, Thom A, Prowse C, Comondore V, Orovan W et al (2010) A cost-analysis comparison of laparoscopic radical prostatectomy versus open radical prostatectomy: the McMaster Institute of Urology experience. Can Urol Assoc J 4(4):237–241PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Sugihara T, Yasunaga H, Horiguchi H, Matsui H, Fujimura T, Nishimatsu H et al (2014) Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012–2013. Cancer Sci 105(11):1421–1426PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60(5):864–868PubMedCrossRefGoogle Scholar
  29. 29.
    Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW (2004) Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 63(5):819–822PubMedCrossRefGoogle Scholar
  30. 30.
    Wood DP, Schulte R, Dunn RL, Hollenbeck BK, Saur R, Wolf JS Jr et al (2007) Short-term health outcome differences between robotic and conventional radical prostatectomy. Urology. 70(5):945–949PubMedCrossRefGoogle Scholar
  31. 31.
    Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML et al (2009) Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 103(4):448–453PubMedCrossRefGoogle Scholar
  32. 32.
    Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G et al (2009) Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int. 104(7):991–995PubMedCrossRefGoogle Scholar
  33. 33.
    D’Alonzo RC, Gan TJ, Moul JW, Albala DM, Polascik TJ, Robertson CN et al (2009) A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth 21(5):322–328PubMedCrossRefGoogle Scholar
  34. 34.
    Di Pierro GB, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A (2011) A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 59(1):1–6PubMedCrossRefGoogle Scholar
  35. 35.
    Philippou P, Waine E, Rowe E (2012) Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. J Endourol 26(8):1002–1008PubMedCrossRefGoogle Scholar
  36. 36.
    Jackson MA, Bellas N, Siegrist T, Haddock P, Staff I, Laudone V et al (2016) Experienced open vs early robotic-assisted laparoscopic radical prostatectomy: a 10-year prospective and retrospective comparison. Urology 91:111–118PubMedCrossRefGoogle Scholar
  37. 37.
    Fracalanza S, Ficarra V, Cavalleri S, Galfano A, Novara G, Mangano A et al (2008) Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study. BJU Int 101(9):1145–1149PubMedCrossRefGoogle Scholar
  38. 38.
    Tewari A, Srivasatava A, Menon M (2003) Members of the VIPT. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 92(3):205–210PubMedCrossRefGoogle Scholar
  39. 39.
    Nadler RB, Casey JT, Zhao LC, Navai N, Smith ZL, Zhumkhawala A et al (2010) Is the transition from open to robotic prostatectomy fair to your patients? A single-surgeon comparison with 2-year follow-up. J Robot Surg 3(4):201–207PubMedCrossRefGoogle Scholar
  40. 40.
    Lo KL, Ng CF, Lam CN, Hou SS, To KF, Yip SK (2010) Short-term outcome of patients with robot-assisted versus open radical prostatectomy: for localised carcinoma of prostate. Hong Kong Med J 16(1):31–35PubMedGoogle Scholar
  41. 41.
    Doumerc N, Yuen C, Savdie R, Rahman MB, Rasiah KK, Pe Benito R et al (2010) Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int. 106(3):378–384PubMedCrossRefGoogle Scholar
  42. 42.
    Choo MS, Choi WS, Cho SY, Ku JH, Kim HH, Kwak C (2013) Impact of prostate volume on oncological and functional outcomes after radical prostatectomy: robot-assisted laparoscopic versus open retropubic. Korean J Urol 54(1):15–21PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Lott FM, Favorito LA (2015) Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer. Acta Cir Bras 30(3):229–234PubMedCrossRefGoogle Scholar
  44. 44.
    Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P (2012) Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 62(1):1–15PubMedCrossRefGoogle Scholar
  45. 45.
    Pearce SM, Pariser JJ, Karrison T, Patel SG, Eggener SE (2016) Comparison of perioperative and early oncologic outcomes between open and robotic assisted laparoscopic prostatectomy in a contemporary population based cohort. J Urol 196(1):76–81PubMedCrossRefGoogle Scholar
  46. 46.
    Chuang AY, Epstein JI (2008) Positive surgical margins in areas of capsular incision in otherwise organ-confined disease at radical prostatectomy: histologic features and pitfalls. Am J Surg Pathol 32(8):1201–1206PubMedCrossRefGoogle Scholar
  47. 47.
    Ryu J, Kwon T, Kyung YS, Hong S, You D, Jeong IG et al (2013) Retropubic versus robot-assisted laparoscopic prostatectomy for prostate cancer: a comparative study of postoperative complications. Korean J Urol 54(11):756–761PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderang U, Thorsteinsdottir T et al (2015) Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial. Eur Urol 68(2):216–225PubMedCrossRefGoogle Scholar
  49. 49.
    Son SJ, Lee SC, Jeong CW, Jeong SJ, Byun SS, Lee SE (2013) Comparison of continence recovery between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy: a single surgeon experience. Korean J Urol 54(9):598–602PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Burgess SV, Atug F, Castle EP, Davis R, Thomas R (2006) Cost analysis of radical retropubic, perineal, and robotic prostatectomy. J Endourol 20(10):827–830PubMedCrossRefGoogle Scholar
  51. 51.
    Tomaszewski JJ, Matchett JC, Davies BJ, Jackman SV, Hrebinko RL, Nelson JB (2012) Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy. Urology 80(1):126–129PubMedCrossRefGoogle Scholar
  52. 52.
    Rozet F, Jaffe J, Braud G, Harmon J, Cathelineau X, Barret E et al (2007) A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience. J Urol 178(2):478–482PubMedCrossRefGoogle Scholar
  53. 53.
    Trabulsi EJ, Zola JC, Gomella LG, Lallas CD (2010) Transition from pure laparoscopic to robotic-assisted radical prostatectomy: a single surgeon institutional evolution. Urol Oncol. 28(1):81–85PubMedCrossRefGoogle Scholar
  54. 54.
    Hakimi AA, Blitstein J, Feder M, Shapiro E, Ghavamian R (2009) Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: single-surgeon experience. Urology 73(1):119–123PubMedCrossRefGoogle Scholar
  55. 55.
    Porpiglia F, Morra I, Lucci Chiarissi M, Manfredi M, Mele F, Grande S et al (2013) Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol 63(4):606–614PubMedCrossRefGoogle Scholar
  56. 56.
    Magheli A, Gonzalgo ML, Su LM, Guzzo TJ, Netto G, Humphreys EB et al (2011) Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int 107(12):1956–1962PubMedCrossRefGoogle Scholar
  57. 57.
    Busch J, Gonzalgo ML, Leva N, Ferrari M, Cash H, Kempkensteffen C et al (2015) Matched comparison of robot-assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients. World J Urol 33(3):397–402PubMedCrossRefGoogle Scholar
  58. 58.
    Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C (2011) Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. J Sex Med 8(5):1503–1512PubMedCrossRefGoogle Scholar
  59. 59.
    Villamil W, Billordo Peres N, Martinez P, Giudice C, Liyo J, Garcia Marchinena P et al (2013) Incidence and location of positive surgical margins following open, pure laparoscopic, and robotic-assisted radical prostatectomy and its relation with neurovascular preservation: a single-institution experience. J Robot Surg 7(1):21–27PubMedCrossRefGoogle Scholar
  60. 60.
    Sylvester RJ, Canfield SE, Lam TB, Marconi L, MacLennan S, Yuan Y et al (2016) Conflict of evidence: resolving discrepancies when findings from randomized controlled trials and meta-analyses disagree. Eur Urol 71:811–819PubMedCrossRefGoogle Scholar
  61. 61.
    Evans SM, Nag N, Roder D, Brooks A, Millar JL, Moretti KL et al (2016) Development of an international prostate cancer outcomes registry. BJU Int 117(Suppl 4):60–67PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Urology and Nephrology Research Center, Shahid Labbafinejad Medical CenterShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Department of UrologyAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of UrologyMassachusetts General HospitalBostonUSA
  4. 4.Sydney Adventist Hospital Clinical SchoolUniversity of SydneySydneyAustralia

Personalised recommendations