Abstract
Context: Perioperative complications are a major surgical outcome for radical prostatectomy (RP). Objective: Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications. 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). Evidence synthesis: We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p <0.00001) and transfusion rate (odds ratio [OR]: 7.55; p <0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p = 0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach. Conclusions: RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach.
| Original language | English |
|---|---|
| Pages (from-to) | 431-452 |
| Number of pages | 22 |
| Journal | European Urology |
| Volume | 62 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Sep 2012 |
Fingerprint
Keywords
- Laparoscopy
- Prostatectomy
- Prostatic neoplasms
- Robotics
ASJC Scopus subject areas
- Urology
Cite this
Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. / Novara, Giacomo; Ficarra, Vincenzo; Rosen, Raymond C.; Artibani, Walter; Costello, Anthony; Eastham, James A.; Graefen, Markus; Guazzoni, Giorgio; Shariat, Shahrokh F.; Stolzenburg, Jens Uwe; Van Poppel, Hendrik; Zattoni, Filiberto; Montorsi, Francesco; Mottrie, Alexandre; Wilson, Timothy G.
In: European Urology, Vol. 62, No. 3, 09.2012, p. 431-452.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy
AU - Novara, Giacomo
AU - Ficarra, Vincenzo
AU - Rosen, Raymond C.
AU - Artibani, Walter
AU - Costello, Anthony
AU - Eastham, James A.
AU - Graefen, Markus
AU - Guazzoni, Giorgio
AU - Shariat, Shahrokh F.
AU - Stolzenburg, Jens Uwe
AU - Van Poppel, Hendrik
AU - Zattoni, Filiberto
AU - Montorsi, Francesco
AU - Mottrie, Alexandre
AU - Wilson, Timothy G.
PY - 2012/9
Y1 - 2012/9
N2 - Context: Perioperative complications are a major surgical outcome for radical prostatectomy (RP). Objective: Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications. 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). Evidence synthesis: We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p <0.00001) and transfusion rate (odds ratio [OR]: 7.55; p <0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p = 0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach. Conclusions: RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach.
AB - Context: Perioperative complications are a major surgical outcome for radical prostatectomy (RP). Objective: Evaluate complication rates following robot-assisted RP (RARP), risk factors for complications after RARP, and surgical techniques to improve complication rates after RARP. We also performed a cumulative analysis of all studies comparing RARP with retropubic RP (RRP) or laparoscopic RP (LRP) in terms of perioperative complications. 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). Evidence synthesis: We retrieved 110 papers evaluating oncologic outcomes following RARP. Overall mean operative time is 152 min; mean blood loss is 166 ml; mean transfusion rate is 2%; mean catheterization time is 6.3 d; and mean in-hospital stay is 1.9 d. The mean complication rate was 9%, with most of the complications being of low grade. Lymphocele/lymphorrea (3.1%), urine leak (1.8%), and reoperation (1.6%) are the most prevalent surgical complications. Blood loss (weighted mean difference: 582.77; p <0.00001) and transfusion rate (odds ratio [OR]: 7.55; p <0.00001) were lower in RARP than in RRP, whereas only transfusion rate (OR: 2.56; p = 0.005) was lower in RARP than in LRP. All the other analyzed parameters were similar, regardless of the surgical approach. Conclusions: RARP can be performed routinely with a relatively small risk of complications. Surgical experience, clinical patient characteristics, and cancer characteristics may affect the risk of complications. Cumulative analyses demonstrated that blood loss and transfusion rates were significantly lower with RARP than with RRP, and transfusion rates were lower with RARP than with LRP, although all other features were similar regardless of the surgical approach.
KW - Laparoscopy
KW - Prostatectomy
KW - Prostatic neoplasms
KW - Robotics
UR - http://www.scopus.com/inward/record.url?scp=84864460970&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864460970&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2012.05.044
DO - 10.1016/j.eururo.2012.05.044
M3 - Article
VL - 62
SP - 431
EP - 452
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 3
ER -