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Title: Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy
Authors: 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 #
Issue Date: Sep-2012
Publisher: Elsevier Science
Series Title: European Urology vol:62 issue:3 pages:431-452
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, searchingMedline, Embase, andWebof Science databases.Afree-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.
ISSN: 0302-2838
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Screening, Diagnostics and Biomarkers (-)
× corresponding author
# (joint) last author

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