Document Detail


Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy.
MedLine Citation:
PMID:  22749851     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited.
OBJECTIVE: Evaluate lymph node yield, positive surgical margins (PSMs), use of adjuvant therapy, and biochemical recurrence (BCR)-free survival following RARP and perform a cumulative analysis of all studies comparing the oncologic outcomes of RARP and retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP).
EVIDENCE ACQUISITION: A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK) and Stata 11.0 SE software (StataCorp, College Station, TX, USA).
EVIDENCE SYNTHESIS: We retrieved 79 papers evaluating oncologic outcomes following RARP. The mean PSM rate was 15% in all comers and 9% in pathologically localized cancers, with some tumor characteristics being the most relevant predictors of PSMs. Several surgeon-related characteristics or procedure-related issues may play a major role in PSM rates. With regard to BCR, the very few papers with a follow-up duration >5 yr demonstrated 7-yr BCR-free survival estimates of approximately 80%. Finally, all the cumulative analyses comparing RARP with RRP and comparing RARP with LRP demonstrated similar overall PSM rates (RARP vs RRP: odds ratio [OR]: 1.21; p=0.19; RARP vs LRP: OR: 1.12; p=0.47), pT2 PSM rates (RARP vs RRP: OR: 1.25; p=0.31; RARP vs LRP: OR: 0.99; p=0.97), and BCR-free survival estimates (RARP vs RRP: hazard ratio [HR]: 0.9; p=0.526; RARP vs LRP: HR: 0.5; p=0.141), regardless of the surgical approach.
CONCLUSIONS: PSM rates are similar following RARP, RRP, and LRP. The few data available on BCR from high-volume centers are promising, but definitive comparisons with RRP or LRP are not currently possible. Finally, significant data on cancer-specific mortality are not currently available.
Authors:
Giacomo Novara; Vincenzo Ficarra; Simone Mocellin; Thomas E Ahlering; Peter R Carroll; Markus Graefen; Giorgio Guazzoni; Mani Menon; Vipul R Patel; Shahrokh F Shariat; Ashutosh K Tewari; Hendrik Van Poppel; Filiberto Zattoni; Francesco Montorsi; Alexandre Mottrie; Raymond C Rosen; Timothy G Wilson
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2012-06-02
Journal Detail:
Title:  European urology     Volume:  62     ISSN:  1873-7560     ISO Abbreviation:  Eur. Urol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-01     Completed Date:  2013-01-07     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  382-404     Citation Subset:  IM    
Copyright Information:
Copyright © 2012. Published by Elsevier B.V.
Affiliation:
University of Padua, Padua, Italy. giacomo.novara@unipd.it
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MeSH Terms
Descriptor/Qualifier:
Chemotherapy, Adjuvant
Chi-Square Distribution
Disease-Free Survival
Evidence-Based Medicine
Humans
Laparoscopy* / adverse effects,  mortality
Lymph Node Excision
Male
Multivariate Analysis
Odds Ratio
Proportional Hazards Models
Prostate-Specific Antigen / blood
Prostatectomy / adverse effects,  methods*,  mortality
Prostatic Neoplasms / blood,  mortality,  pathology,  surgery*
Radiotherapy, Adjuvant
Risk Assessment
Risk Factors
Robotics*
Surgery, Computer-Assisted* / adverse effects,  mortality
Survival Analysis
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
P30 CA062203/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
EC 3.4.21.77/Prostate-Specific Antigen
Comments/Corrections
Comment In:
Eur Urol. 2013 Feb;63(2):e27-8   [PMID:  23182552 ]
Eur Urol. 2013 Feb;63(2):e29-31   [PMID:  23218764 ]
Eur Urol. 2012 Sep;62(3):365-7   [PMID:  22705383 ]

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