Abstract
Systematic reviews (SR) produce the best evidence comparing open (RRP), laparoscopic
(LRP), and robotic (RARP) radical prostatectomy (RP). However, the hyperfiltration
of evidence generates very specific scenarios that reduce the power of extrapolation.
To compare RP evidence regarding demographics using a new methodology called reverse
systematic review (RSR). Between 2000 and 2020, 8 databases were searched for SR studies
on RRP, LRP, or RARP. All references were captured and analyzed over time in 80 SR.
Total of 1724 reports (nr = 752, 43.7% for RARP; nr = 559, 32.4% for RRP; nr = 413, 23.9% for LRP) described 1,353,485 patients (881,719, 65.1% RRP; 366,006,
27.0% RARP; 105,760, 7.8% LRP). Patients/center/year was higher in RARP compared to
LRP and RRP, median 50.0, 40.0, and 36.66, respectively, P < .001. Surgeons per study was lesser in RARP and LRP compared to RRP, median 2.0,
2.0, and 6.0, respectively, P < .001. Study duration and follow-up in years was shorter in RARP compared to LRP
and RRP, median 2.6, 3.0, and 4.0, respectively, P < .001. Cumulative RARP reports predominate in North America (55.7%, nr = 468) and Asia (47.8%, nr =129), while LRP predominate in Europe (42.3%, nr =230) and RRP in Oceania (45.1%, nr = 23). After 2010 all continents began to accumulate more patients in the robotic
approach. Potential biases related to shorter follow-up, greater volume centers, and
surgeons were identified favoring the RARP. Analyzing the context of the available
evidence is essential to compare techniques. Influenced by economic and scientific
interests, robotic surgery was developed in centers with a higher volume of surgeries,
characterizing potential biases when comparing techniques in the clinical shared decision.
Keywords
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Article info
Publication history
Published online: February 16, 2023
Accepted:
February 13,
2023
Received in revised form:
February 9,
2023
Received:
July 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
