Comparative functional, perioperative and oncological outcomes of robot-assisted and open radical prostatectomy: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP), including randomized trials and prospective comparative studies. Across 27 studies and 38,530 patients, RARP was associated with less intraoperative blood loss (mean difference −576.78), fewer transfusions (OR 0.27), shorter hospital stays (mean difference −1.44 days), and fewer postoperative complications (OR 0.59). Functional outcomes also favored RARP for urinary continence recovery at 3 months and erectile function recovery (OR 1.43). Biochemical recurrence was lower at 24 months, while no significant difference was reported before 12 months.

Key findings

• RARP was associated with lower transfusion rates than ORP (OR 0.27; p < 0.0001).
• RARP was associated with less blood loss (mean difference −576.78; p < 0.01) and shorter hospitalization (mean difference −1.44 days; p < 0.0001).
• Postoperative complications were less frequent with RARP (OR 0.59; p = 0.002).
• Functional recovery favored RARP; erectile function recovery had an OR of 1.43, and continence recovery was superior at 3 months.

Why it matters

The findings suggest that surgical approach may influence perioperative morbidity and recovery after radical prostatectomy, alongside functional outcomes important to patients. The review also reports no significant short-term difference in biochemical recurrence and a lower rate at 24 months with RARP. These comparisons can inform understanding of the trade-offs between approaches, while the evidence base and follow-up warrant caution.

What to keep in mind

Few randomized trials directly compare the procedures, and the authors call for further randomized trials with extended follow-up. The reported oncological findings include short-term follow-up.