Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: a systematic review and mixed treatment comparison meta-analysis

Clare Robertson, Andrew Close, Cynthia Fraser, Tara Gurung, Xueli Jia, Pawana Sharma, Luke Vale, Craig Ramsay, Robert Pickard

Research output: Contribution to journalArticle

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Abstract

Objective
To compare the effectiveness of robot-assisted and standard laparoscopic prostatectomy.
Methods
A care pathway was described.
We performed a systematic literature review based on a search of Medline, Medline in Process, Embase, Biosis, Science Citation Index, Cochrane Controlled Trials Register, Current Controlled Trials, Clinical Trials, WHO International Clinical Trials Registry and NIH Reporter, the Health Technology Assessment databases, the Database of Abstracts of Reviews of Effects, and relevant conference abstracts up to 31st October 2010). Additionally, reference lists were scanned, an expert panel consulted, and websites of manufacturers, professional organisations, and regulatory bodies were checked.
We selected randomised controlled trials (RCTs) and non-randomised comparative studies, published after 1st January 1995, including men with localised prostate cancer undergoing robot-assisted or laparoscopic prostatectomy compared with the other procedure or with open prostatectomy. Studies where at least 90% of included men had clinical tumour stages T1 to T2 and which reported at least one of our specified outcomes were eligible for inclusion.
A mixed-treatment comparison meta-analysis was performed to generate comparative statistics on specified outcomes.
Results
We included data from 19 064 men across one RCT and 57 non-randomised comparative reports.
Robotic prostatectomy had a lower risk of major intra-operative harms such as organ injury [0.4% robotic vs 2.9% laparoscopic], odds ratio ([OR] {95% credible interval [CrI]} 0.16 [0.03 to 0.76]), and a lower rate of surgical margins positive for cancer [17.6% robotic vs 23.6% laparoscopic], OR [95% CrI] 0.69 [0.51 to 0.96]). There was no evidence of a difference in the proportion of men with urinary incontinence at 12 months (OR [95% CrI] 0.55 [0.09 to 2.84]). There were insufficient data on sexual dysfunction.
Surgeon learning rates for the procedures did not differ, although data were limited.
Conclusions
Men undergoing robotic prostatectomy appear to have reduced surgical morbidity, and a lower risk of a positive surgical margin, which may reduce rates of cancer recurrence and the need for further treatment, but considerable uncertainty surrounds these results.
We found no evidence that men undergoing robotic prostatectomy are disadvantaged in terms of early outcomes.
We were unable to determine longer-term relative effectiveness.
Original languageEnglish
Pages (from-to)798-812
Number of pages15
JournalBJU International
Volume112
Issue number6
Early online date26 Jul 2013
DOIs
Publication statusPublished - Oct 2013

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Prostatectomy
Robotics
Prostatic Neoplasms
Odds Ratio
Therapeutics
Clinical Trials
Databases
Biomedical Technology Assessment
Neoplasms
Urinary Incontinence
Vulnerable Populations
Uncertainty
Registries
Network Meta-Analysis
Learning
Morbidity
Recurrence
Wounds and Injuries

Keywords

  • prostate cancer
  • robotic surgery
  • laparascopic surgery
  • systematic review
  • meta-analysis

Cite this

Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer : a systematic review and mixed treatment comparison meta-analysis. / Robertson, Clare; Close, Andrew; Fraser, Cynthia; Gurung, Tara; Jia, Xueli; Sharma, Pawana; Vale, Luke; Ramsay, Craig; Pickard, Robert.

In: BJU International, Vol. 112, No. 6, 10.2013, p. 798-812.

Research output: Contribution to journalArticle

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title = "Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: a systematic review and mixed treatment comparison meta-analysis",
abstract = "ObjectiveTo compare the effectiveness of robot-assisted and standard laparoscopic prostatectomy.MethodsA care pathway was described.We performed a systematic literature review based on a search of Medline, Medline in Process, Embase, Biosis, Science Citation Index, Cochrane Controlled Trials Register, Current Controlled Trials, Clinical Trials, WHO International Clinical Trials Registry and NIH Reporter, the Health Technology Assessment databases, the Database of Abstracts of Reviews of Effects, and relevant conference abstracts up to 31st October 2010). Additionally, reference lists were scanned, an expert panel consulted, and websites of manufacturers, professional organisations, and regulatory bodies were checked.We selected randomised controlled trials (RCTs) and non-randomised comparative studies, published after 1st January 1995, including men with localised prostate cancer undergoing robot-assisted or laparoscopic prostatectomy compared with the other procedure or with open prostatectomy. Studies where at least 90{\%} of included men had clinical tumour stages T1 to T2 and which reported at least one of our specified outcomes were eligible for inclusion.A mixed-treatment comparison meta-analysis was performed to generate comparative statistics on specified outcomes.ResultsWe included data from 19 064 men across one RCT and 57 non-randomised comparative reports.Robotic prostatectomy had a lower risk of major intra-operative harms such as organ injury [0.4{\%} robotic vs 2.9{\%} laparoscopic], odds ratio ([OR] {95{\%} credible interval [CrI]} 0.16 [0.03 to 0.76]), and a lower rate of surgical margins positive for cancer [17.6{\%} robotic vs 23.6{\%} laparoscopic], OR [95{\%} CrI] 0.69 [0.51 to 0.96]). There was no evidence of a difference in the proportion of men with urinary incontinence at 12 months (OR [95{\%} CrI] 0.55 [0.09 to 2.84]). There were insufficient data on sexual dysfunction.Surgeon learning rates for the procedures did not differ, although data were limited.ConclusionsMen undergoing robotic prostatectomy appear to have reduced surgical morbidity, and a lower risk of a positive surgical margin, which may reduce rates of cancer recurrence and the need for further treatment, but considerable uncertainty surrounds these results.We found no evidence that men undergoing robotic prostatectomy are disadvantaged in terms of early outcomes.We were unable to determine longer-term relative effectiveness.",
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T1 - Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer

T2 - a systematic review and mixed treatment comparison meta-analysis

AU - Robertson, Clare

AU - Close, Andrew

AU - Fraser, Cynthia

AU - Gurung, Tara

AU - Jia, Xueli

AU - Sharma, Pawana

AU - Vale, Luke

AU - Ramsay, Craig

AU - Pickard, Robert

N1 - © 2013 The Authors. BJU International © 2013 BJU International.

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N2 - ObjectiveTo compare the effectiveness of robot-assisted and standard laparoscopic prostatectomy.MethodsA care pathway was described.We performed a systematic literature review based on a search of Medline, Medline in Process, Embase, Biosis, Science Citation Index, Cochrane Controlled Trials Register, Current Controlled Trials, Clinical Trials, WHO International Clinical Trials Registry and NIH Reporter, the Health Technology Assessment databases, the Database of Abstracts of Reviews of Effects, and relevant conference abstracts up to 31st October 2010). Additionally, reference lists were scanned, an expert panel consulted, and websites of manufacturers, professional organisations, and regulatory bodies were checked.We selected randomised controlled trials (RCTs) and non-randomised comparative studies, published after 1st January 1995, including men with localised prostate cancer undergoing robot-assisted or laparoscopic prostatectomy compared with the other procedure or with open prostatectomy. Studies where at least 90% of included men had clinical tumour stages T1 to T2 and which reported at least one of our specified outcomes were eligible for inclusion.A mixed-treatment comparison meta-analysis was performed to generate comparative statistics on specified outcomes.ResultsWe included data from 19 064 men across one RCT and 57 non-randomised comparative reports.Robotic prostatectomy had a lower risk of major intra-operative harms such as organ injury [0.4% robotic vs 2.9% laparoscopic], odds ratio ([OR] {95% credible interval [CrI]} 0.16 [0.03 to 0.76]), and a lower rate of surgical margins positive for cancer [17.6% robotic vs 23.6% laparoscopic], OR [95% CrI] 0.69 [0.51 to 0.96]). There was no evidence of a difference in the proportion of men with urinary incontinence at 12 months (OR [95% CrI] 0.55 [0.09 to 2.84]). There were insufficient data on sexual dysfunction.Surgeon learning rates for the procedures did not differ, although data were limited.ConclusionsMen undergoing robotic prostatectomy appear to have reduced surgical morbidity, and a lower risk of a positive surgical margin, which may reduce rates of cancer recurrence and the need for further treatment, but considerable uncertainty surrounds these results.We found no evidence that men undergoing robotic prostatectomy are disadvantaged in terms of early outcomes.We were unable to determine longer-term relative effectiveness.

AB - ObjectiveTo compare the effectiveness of robot-assisted and standard laparoscopic prostatectomy.MethodsA care pathway was described.We performed a systematic literature review based on a search of Medline, Medline in Process, Embase, Biosis, Science Citation Index, Cochrane Controlled Trials Register, Current Controlled Trials, Clinical Trials, WHO International Clinical Trials Registry and NIH Reporter, the Health Technology Assessment databases, the Database of Abstracts of Reviews of Effects, and relevant conference abstracts up to 31st October 2010). Additionally, reference lists were scanned, an expert panel consulted, and websites of manufacturers, professional organisations, and regulatory bodies were checked.We selected randomised controlled trials (RCTs) and non-randomised comparative studies, published after 1st January 1995, including men with localised prostate cancer undergoing robot-assisted or laparoscopic prostatectomy compared with the other procedure or with open prostatectomy. Studies where at least 90% of included men had clinical tumour stages T1 to T2 and which reported at least one of our specified outcomes were eligible for inclusion.A mixed-treatment comparison meta-analysis was performed to generate comparative statistics on specified outcomes.ResultsWe included data from 19 064 men across one RCT and 57 non-randomised comparative reports.Robotic prostatectomy had a lower risk of major intra-operative harms such as organ injury [0.4% robotic vs 2.9% laparoscopic], odds ratio ([OR] {95% credible interval [CrI]} 0.16 [0.03 to 0.76]), and a lower rate of surgical margins positive for cancer [17.6% robotic vs 23.6% laparoscopic], OR [95% CrI] 0.69 [0.51 to 0.96]). There was no evidence of a difference in the proportion of men with urinary incontinence at 12 months (OR [95% CrI] 0.55 [0.09 to 2.84]). There were insufficient data on sexual dysfunction.Surgeon learning rates for the procedures did not differ, although data were limited.ConclusionsMen undergoing robotic prostatectomy appear to have reduced surgical morbidity, and a lower risk of a positive surgical margin, which may reduce rates of cancer recurrence and the need for further treatment, but considerable uncertainty surrounds these results.We found no evidence that men undergoing robotic prostatectomy are disadvantaged in terms of early outcomes.We were unable to determine longer-term relative effectiveness.

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KW - robotic surgery

KW - laparascopic surgery

KW - systematic review

KW - meta-analysis

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JO - BJU International

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SN - 1464-4096

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