Minimally invasive radical prostatectomy versus open radical prostatectomy: A systematic review and meta-analysis of randomized control trials.

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics Pub Date : 2025-04-27 eCollection Date: 2025-01-01 DOI:10.1016/j.clinsp.2025.100636

Caio Felipe Araujo Matalani, Mateus Silva Santos Costa, Marcelo Ribeiro da Rocha, Roberto Iglesias Lopes, Thalita Bento Talizin, José Bessa Júnior, William Carlos Nahas, Leopoldo Alves Ribeiro-Filho, Caio Vinicius Suartz

{"title":"Minimally invasive radical prostatectomy versus open radical prostatectomy: A systematic review and meta-analysis of randomized control trials.","authors":"Caio Felipe Araujo Matalani, Mateus Silva Santos Costa, Marcelo Ribeiro da Rocha, Roberto Iglesias Lopes, Thalita Bento Talizin, José Bessa Júnior, William Carlos Nahas, Leopoldo Alves Ribeiro-Filho, Caio Vinicius Suartz","doi":"10.1016/j.clinsp.2025.100636","DOIUrl":null,"url":null,"abstract":"Objective: To evaluate the comparative outcomes of Minimally Invasive Radical Prostatectomy (MIRP) versus Open Radical Prostatectomy (ORP) to treat localized prostate cancer, using only Randomized Controlled Trials (RCTs) to ensure high-quality evidence.Method: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, focusing solely on RCTs comparing MIRP (robot-assisted or laparoscopic surgery) and ORP. Literature searches across multiple databases, including Cochrane Library, Medline, Embase, Lilacs, Scopus, Web of Science, NIH, Clinical Trials, and EU Clinical Trials Register, identified studies meeting predefined PICOT criteria. Four RCTs met inclusion criteria ‒ two representing the same cohort of patients ‒ and were analyzed for perioperative, functional, and oncologic outcomes. Quality assessment utilized the ROB-2 tool to gauge the risk of bias.Results: Three RCTs encompassing 1051 patients were analyzed. MIRP demonstrated statistically significant benefits over ORP in terms of reduced perioperative blood loss (Standardized Mean Difference [SMD = -3.058], p = 0.006), lower transfusion rates (Odds Ratio [OR = 0.137]; p = 0.009), and fewer overall complications (OR = 0.465; p = 0001). However, no significant differences were found in long-term oncologic and functional outcomes, including urinary continence and erectile function. Positive surgical margins and additional treatments also did not differ significantly between groups.Conclusion: This systematic review and meta-analysis of RCTs indicated that MIRP offers perioperative advantages over ORP, supporting its role as a safe and effective option for localized prostate cancer.","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"100636"},"PeriodicalIF":2.2000,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059318/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clinsp.2025.100636","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: To evaluate the comparative outcomes of Minimally Invasive Radical Prostatectomy (MIRP) versus Open Radical Prostatectomy (ORP) to treat localized prostate cancer, using only Randomized Controlled Trials (RCTs) to ensure high-quality evidence.

Method: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, focusing solely on RCTs comparing MIRP (robot-assisted or laparoscopic surgery) and ORP. Literature searches across multiple databases, including Cochrane Library, Medline, Embase, Lilacs, Scopus, Web of Science, NIH, Clinical Trials, and EU Clinical Trials Register, identified studies meeting predefined PICOT criteria. Four RCTs met inclusion criteria ‒ two representing the same cohort of patients ‒ and were analyzed for perioperative, functional, and oncologic outcomes. Quality assessment utilized the ROB-2 tool to gauge the risk of bias.

Results: Three RCTs encompassing 1051 patients were analyzed. MIRP demonstrated statistically significant benefits over ORP in terms of reduced perioperative blood loss (Standardized Mean Difference [SMD = -3.058], p = 0.006), lower transfusion rates (Odds Ratio [OR = 0.137]; p = 0.009), and fewer overall complications (OR = 0.465; p = 0001). However, no significant differences were found in long-term oncologic and functional outcomes, including urinary continence and erectile function. Positive surgical margins and additional treatments also did not differ significantly between groups.

Conclusion: This systematic review and meta-analysis of RCTs indicated that MIRP offers perioperative advantages over ORP, supporting its role as a safe and effective option for localized prostate cancer.

查看原文本刊更多论文

微创根治性前列腺切除术与开放式根治性前列腺切除术：随机对照试验的系统回顾和荟萃分析。

目的：评价微创根治性前列腺切除术（MIRP）与开放式根治性前列腺切除术（ORP）治疗局限性前列腺癌的比较效果，仅采用随机对照试验（rct）来确保高质量的证据。方法：根据PRISMA指南进行系统回顾和荟萃分析，仅关注比较MIRP（机器人辅助或腹腔镜手术）和ORP的随机对照试验。文献检索跨越多个数据库，包括Cochrane Library， Medline, Embase, Lilacs, Scopus, Web of Science， NIH， Clinical Trials和EU Clinical Trials Register，确定了符合预定义PICOT标准的研究。四项rct符合纳入标准，其中两项代表相同的患者队列，并对围手术期、功能和肿瘤预后进行分析。质量评估采用rob2工具评估偏倚风险。结果：共分析了3项rct，共1051例患者。与ORP相比，MIRP在减少围手术期失血量（标准化平均差[SMD = -3.058], p = 0.006）、降低输血率(优势比[OR = 0.137]；p = 0.009)，总并发症较少(OR = 0.465；P = 0001)。然而，在长期肿瘤和功能结果（包括尿失禁和勃起功能）方面没有发现显著差异。阳性手术切缘和额外治疗在两组之间也没有显著差异。结论：本系统综述和荟萃分析的随机对照试验表明，MIRP比ORP具有围手术期优势，支持其作为局部前列腺癌安全有效的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.