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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Clinical Genitourinary Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- New evidence pyramid.Evid Based Med. 2016; 21: 125-127https://doi.org/10.1136/ebmed-2016-110401
- Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.Syst Rev. 2015; 4: 1https://doi.org/10.1186/2046-4053-4-1
- Development and application of reverse systematic review on laparoscopic radical prostatectomy.Urol Oncol. 2019; 37: 647-658https://doi.org/10.1016/j.urolonc.2019.06.004
- An international registry of systematic-review protocols.Lancet. 2011; 377: 108-109https://doi.org/10.1016/S0140-6736(10)60903-8
- Establishing a minimum dataset for prospective registration of systematic reviews: an international consultation.PLoS One. 2011; 6: e27319https://doi.org/10.1371/journal.pone.0027319
SCImago nd. SJR — SCImago Journal & Country Rank [Portal]. Accessed: March, 2023. Available at: http://www.scimagojr.com.
- EAU Guidelines. Edn.in: Presented at the EAU Annual Congress Amsterdam 2022. EAU Guidelines Office, Arnhem, the Netherlands. 2022
- Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options.J Urol. 2018; 199: 683-690https://doi.org/10.1016/j.juro.2017.11.095
- Estimation of the acquisition and operating costs for robotic surgery.JAMA. 2018; 320: 835-836https://doi.org/10.1001/jama.2018.9219
- The devil is still in the details of robotic assisted radical prostatectomy data.World J Urol. 2022; 40: 1239-1240https://doi.org/10.1007/s00345-022-03962-z.11
- Incontinence after laparoscopic radical prostatectomy: a reverse systematic review.Int Braz J Urol. 2022; 48: 389-396
- Sexual function criteria post laparoscopic radical prostatectomy: a reverse systematic review.Int Urol Nephrol. 2022; 54: 2097-2104
- The "Natural History" of evidence on radical prostatectomy: what have 20 years of robots given us?.Eur Urol Focus. 2022; 8: 1859-1860
Published online: February 16, 2023
Accepted: February 13, 2023
Received in revised form: February 9, 2023
Received: July 25, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Elsevier Inc. All rights reserved.