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Updated: Aug 6, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Open, Laparoscopic, and Robot-Assisted Radical Prostatectomy Oncological Results: A Reverse Systematic Review
Tomás Bernardo Costa Moretti1,2, Luís Alberto Magna3, Leonardo Oliveira Reis1,2,4
1Doctoral Program in Medical Pathophysiology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil.
Reverse Systematic Review (RSR) shows minimally invasive radical prostatectomy (RP) techniques like laparoscopic (LRP) and robotic (RARP) offer better oncological outcomes than retropubic radical prostatectomy (RRP). RSR effectively compares positive surgical margin and biochemical recurrence rates across diverse patient populations.
Area of Science:
- Urology
- Surgical Oncology
- Evidence-Based Medicine
Background:
- Systematic reviews (SR) are standard for comparing radical prostatectomy (RP) techniques: retropubic (RRP), laparoscopic (LRP), and robotic (RARP).
- While minimally invasive surgery (MIS) excels in perioperative results, oncological outcome superiority among RP techniques remains unclear.
- A novel Reverse Systematic Review (RSR) methodology was developed to analyze heterogeneous samples for population-level oncological outcome comparisons.
Purpose of the Study:
- To apply the RSR methodology to compare oncological outcomes (positive surgical margin [PSM] and biochemical recurrence [BCR]) of RRP, LRP, and RARP.
- To evaluate the effectiveness of RSR in synthesizing evidence from a broad range of studies for comparative analysis.
Main Methods:
- Conducted an RSR by searching eight databases (2000-2020) for SR studies on RRP, LRP, and RARP, capturing 1724 reports.
- Extracted and compared preoperative and oncological outcomes (PSM, BCR) from RRP, LRP, and RARP studies.
- Utilized nonlinear regression to model BCR over time (1-10 years) and analyzed statistical differences in PSM rates.
Main Results:
- Analysis included 1,353,485 patients across 559 RRP, 413 LRP, and 752 RARP reports.
- PSM rates were 23.6% (RRP), 20.7% (LRP), and 19.2% (RARP), with RRP showing a statistically significant higher rate (p < 0.001).
- BCR projections indicated varied long-term rates, with RARP data limited by the absence of long-term follow-up studies.
Conclusions:
- RSR is effective for generating population-based, heterogeneous samples to compare oncological outcomes of RP techniques.
- Minimally invasive surgery (LRP and RARP) demonstrated superior oncological results compared to RRP, particularly regarding PSM.
- The study highlights the maturity of RRP and LRP follow-up data and the impact of limited long-term RARP data on BCR assessment.
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