Outcomes of robot-assisted radical prostatectomy with novel robotic platforms vs da Vinci multiport systems: a systematic review and network meta-analysis.
Francesco Chierigo, Giuseppe Fallara, Massimiliano Depalma, Marco Tozzi, Alberto Quistini, Roberto Bianchi, Martina Maggi, Guglielmo Mantica, Cosimo De Nunzio, Rocco Damiano, Alessandro Veccia, Alessandro Antonelli, Francesco Porpiglia, Pierre Karakiewicz, Riccardo Autorino, Bernardo Rocco, Matteo Ferro
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引用次数: 0
Abstract
Introduction: The introduction of novel robotic platforms has expanded surgical options for robot-assisted radical prostatectomy (RARP). However, comparative outcomes with da Vinci multiport (MP) system remain unclear. This systematic review and network meta-analysis aimed to compare perioperative, early oncological, and functional outcomes of RARP performed with novel robotic platforms versus the da Vinci MP system.
Methods: A systematic literature search was conducted in PubMed, Scopus, and Embase (updated December 22, 2024) following PRISMA guidelines. Eligible studies compared RARP performed with alternative robotic platforms versus da Vinci MP, reporting perioperative, oncological, or functional outcomes. A network meta-analysis was conducted using a random-effects model. Outcomes were expressed as mean differences for continuous variables and odds ratios (OR) for dichotomous variables, with 95% confidence intervals (CI).
Results: Thirty-three studies for a total of 5987 patients were included. Compared to da Vinci MP, da Vinci SP had lower odds of lymph node dissection (OR 0.39, 95% CI 0.26-0.61) and nerve-sparing (OR 0.11, 95% CI 0.02-0.61) but was associated with shorter catheterization (-1.18 days, 95% CI -2.05 to -0.31) and hospital stay (-0.68 days, 95% CI -1.05 to -0.31). Versius, KangDuo, and SHURUI SP had significantly longer operative times (MD 74.00, 95% CI 42.49-105.51; MD 53.96, 95% CI 18.26-89.67; MD 103.88, 95% CI 69.99-137.78, respectively). Hugo RAS had higher intraoperative malfunction rates (OR 6.53, 95% CI 2.17-19.63). Positive surgical margin rates were lower for da Vinci SP (OR 0.70, 95% CI 0.53-0.92) but higher with the perineal approach (OR 6.30, 95% CI 1.53-25.94). PSA persistence, biochemical recurrence, continence and erectile function rates were comparable across platforms.
Conclusion: This is the first network meta-analysis comparing robotic platforms for RARP. While perioperative differences exist, oncological and functional outcomes appear comparable. Future studies should address learning curve effects, cost-effectiveness, and long-term functional outcomes to optimize robotic platform selection.
新型机器人平台的引入扩大了机器人辅助根治性前列腺切除术（RARP）的手术选择。然而，与达芬奇多端口（MP）系统的比较结果尚不清楚。本系统综述和网络荟萃分析旨在比较新型机器人平台与达芬奇MP系统进行RARP的围手术期、早期肿瘤和功能结果。方法：根据PRISMA指南，在PubMed、Scopus和Embase（2024年12月22日更新）中进行系统文献检索。符合条件的研究比较了替代机器人平台与达芬奇MP进行的RARP，报告了围手术期、肿瘤或功能结果。采用随机效应模型进行网络元分析。结果用连续变量的平均差异和二分变量的优势比（OR）表示，有95%的置信区间（CI）。结果：33项研究共纳入5987例患者。与da Vinci MP相比，da Vinci SP有更低的淋巴结清扫率（OR 0.39, 95% CI 0.26-0.61）和神经保留率（OR 0.11, 95% CI 0.02-0.61），但与更短的插管时间（-1.18天，95% CI -2.05至-0.31）和住院时间（-0.68天，95% CI -1.05至-0.31）相关。Versius、KangDuo和SHURUI SP的手术时间明显更长（MD分别为74.00,95% CI 42.49 ~ 105.51； MD为53.96,95% CI 18.26 ~ 89.67； MD为103.88,95% CI 69.99 ~ 137.78）。Hugo RAS术中故障率较高（OR 6.53, 95% CI 2.17-19.63）。da Vinci SP的阳性切缘率较低（OR 0.70, 95% CI 0.53-0.92），但会阴入路的阳性切缘率较高（OR 6.30, 95% CI 1.53-25.94）。PSA持久性、生化复发率、尿失禁率和勃起功能率在各平台具有可比性。结论：这是第一个比较机器人RARP平台的网络meta分析。虽然围手术期存在差异，但肿瘤和功能结果似乎具有可比性。未来的研究应该解决学习曲线效应、成本效益和长期功能结果，以优化机器人平台的选择。
期刊介绍：
Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management.
Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis.
Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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