Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer
How does laparoscopic and robot-assisted laparoscopic surgery compare in the treatment of men with prostate cancer?
Prostate cancer is a common cancer in men, often treated by surgical removal. Traditionally, surgeons used to make an incision on the lower abdomen to take the prostate. This procedure is called open radical prostatectomy (ORP). More recently, surgeons have started to use other ways to perform the same operation. Laparoscopic radical prostatectomy (LRP) allows surgeons to work inside the patient with long instruments and a tiny camera through small incisions. Laparoscopic surgery can be done with the use of a robotic device, which allows the surgeon to have a magnified, three-dimensional view and operate from a console, away from the patient. This procedure is called robotic-assisted radical prostatectomy (RARP). It is unclear whether the newer LRP and RARP approaches are better for patients.
This review identified two randomised controlled trials of 446 men with prostate cancer, with an average age of approximately 60 years, that compared LRP or RARP to ORP.
We found no evidence as to how LRP or RARP compared to ORP in terms of reducing the risk of dying from prostate cancer, preventing the cancer from coming back or dying of any cause. Mens' quality of life was likely similar related to their urinary and sexual function. There appears to be no differences in postoperative surgical complications. LRP or RARP may have a small possibly unimportant effect on postoperative pain at one day and up to one week. However, no difference between RARP and ORP was found at 12 weeks postoperatively. Men having LRP or RARP likely have a shorter hospital stay and may need fewer blood transfusions.
Quality of evidence
We found no trial evidence for any cancer outcome. The evidence for quality of life were moderate; that for overall and serious surgical complications were low quality. Postoperative pain were low (up to one week) and moderate (at 12 weeks) quality of evidence. The quality of evidence for hospital stay and blood transfusions were moderate and low, respectively. Collectively, the most outcomes were low to moderate quality of evidence. This means that our estimates are likely to be close to the truth but that there is a possibility that they may be different.