A total of 110,016 patients formed the basis of this meta-analysis, comprising the largest compilation of radical prostatectomy patients in the literature, according to Dr. Sooriakumaran. Summary data were abstracted on year of publication, pre-operative patient characteristics, positive surgical margins, estimated blood loss, blood transfusions, conversions, length of hospital stay, and total intra- and peri- operative complications, with a further 21 individual peri-operative complications selected a priori for abstraction and analysis.
The open and laparoscopic surgical groups had similar overall positive surgical margin rates, with the robotic group having lower rates. Both minimally invasive approaches showed significantly lower estimated blood loss and rate of blood transfusions, and a shorter length of hospital stay when compared to an open approach. A further decrease in these parameters was seen when robotic assistance was used. Total complication rates were highest for the open approach, intermediate for the laparoscopic group, and lowest for the robotic patients. For the individual complication analysis, the rates for death, readmission, reoperation, ureteral, bladder, and rectal injury, ileus, pneumonia, fistula, and wound infection showed significant differences between groups. They concluded that cost-benefit analysis and longer follo-up studies are necessary prior to concluding superiority of one surgical approach over another.
Presented by Prasanna Sooriakumaran, MD, PhD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria
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