3 years ago

Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer: a Cochrane systematic review

Dragan Ilic, Christie Ann Allan, Jae Hung Jung, Declan Murphy, Mark Frydenberg, Sue M Evans
To determine the effects of laparoscopic radical prostatectomy (LRP), or robotic-assisted radical prostatectomy (RARP), compared to open radical prostatectomy (ORP) in men with localised prostate cancer. We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings with no restrictions on the language of publication or publication status, up until 9 June 2017. We included all randomised or pseudo-randomised controlled trials with a direct comparison of LRP and RARP to ORP. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the quality of the evidence (QoE) according to GRADE. The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions. We included two unique studies with 446 randomised participants with clinically localised prostate cancer. All available outcome data were short-term (up to 3 months). We found no study that addressed the outcome of prostate cancer-specific survival. Based on one trial, RARP likely results in little to no difference in urinary quality of life (mean difference [MD] -1.30, 95% confidence interval [CI] -4.65 to 2.05; moderate QoE) and sexual quality of life (MD 3.90, 95% CI -1.84 to 9.64; moderate QoE). No study addressed the outcomes of biochemical recurrence-free survival or overall survival. Based on one trial, RARP may result in little to no difference in overall surgical complications (risk ratio [RR] 0.41, 95% CI 0.16 to 1.04; low QoE) or serious postoperative complications (RR 0.16, 95% CI 0.02 to 1.32; low QoE). Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at one day (MD -1.05, 95% CI -1.42 to -0.68; low QoE) and up to one week (MD -0.78, 95% CI -1.40 to -0.17; low QoE). Based on one study, RARP likely results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI -0.32 to 0.34; moderate QoE). Based on one study, RARP likely reduces the length of hospital stay (MD -1.72, 95% CI -2.19 to -1.25; moderate QoE). Based on two studies, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI 0.12 to 0.46; low QoE). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1000 men (95% CI 78 fewer to 48 fewer). There is no evidence to inform the comparative effectiveness of LRP or RARP compared to ORP for oncological outcomes. Urinary and sexual quality of life appears similar. Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.14062

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