Surgical Results and Complications for Open, Laparoscopic, and Robot-assisted Radical Prostatectomy: A Reverse...

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Systematic reviews (SRs) demonstrate benefits of minimally invasive surgery for radical prostatectomy (RP).
• Traditional SRs may exclude data, presenting unrepresentative clinical scenarios.
• A novel reverse SR methodology was employed to create a comprehensive database of diverse clinical scenarios.

Purpose of the Study:

• To compare perioperative surgical outcomes and complication rates of open retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robot-assisted radical prostatectomy (RARP) using a reverse SR approach.

Main Methods:

• Searched eight databases for SRs on RRP, LRP, or RARP published between 2000 and 2020.
• Extracted all references from 80 identified SRs for analysis, totaling 1724 articles.
• Compared perioperative outcomes and complications across RRP, LRP, and RARP techniques.

Main Results:

• Analyzed 1,353,485 patients across 559 RRP, 413 LRP, and 752 RARP reports.
• RARP demonstrated higher annual volume of surgery per surgeon (AVSS) and a higher percentage of low-risk patients.
• RARP exhibited lower complication rates (12.3%) compared to LRP (16.3%) and RRP (20.2%), with AVSS significantly correlating with complication rates.

Conclusions:

• The reverse SR approach yielded a representative sample of real-world surgical practice.
• Minimally invasive surgery, particularly RARP, offers superior perioperative and complication outcomes.
• RARP's advantages are linked to less complex cases, higher surgeon volume, and enhanced performance.