전립선암 환자에서 로봇 보조 수술과 복강경 수술의 안전성 및 효과성 비교: 체계적 문헌고찰
Safety and Effectiveness of Robot-Assisted Versus Conventional Laparoscopic Radical Prostatectomy: A Systematic Review of Randomised Controlled Trials
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Objectives: This study aims to compare outcomes of robot-assisted radical prostatectomy (ROBOT) with conventional laparoscopic radical prostatectomy (LAPA). Methods: Systematic searches on Medline, Embase, Cochrane library and five Korean databases were performed from January 2000 to April 2022. Randomised controlled trials (RCTs) were included and a pooled meta-analysis were conducted. The outcomes of interest included perioperative, functional, oncological and pathological outcomes, quality of life, and complications. Results: A total of five RCTs comprising 950 prostate cancer patients were included in the analysis. The total numbers of patients included in ROBOT and LAPA were 667 and 283, respectively. Overall risks of bias were low but the risk of detection bias for subjective outcomes were high. Meta-analysis showed that the operative time of ROBOT was longer than that of LAPA (mean difference [MD] 8.63 minutes, 95% confidence interval [CI] 3.28–13.98, I2=0%). The estimated blood loss was not different between ROBOT and LAPA (MD 3.98 mL, 95% CI -56.19–63.97, I2=83%) but its result was inconclusive. The surgical positive margin was higher in ROBOT but not statistically significant (risk ratio [RR] 1.38, 95% CI 1.00– 1.91, I2=0%). However, continence rates at 3 months (RR 1.16, 95% CI 1.01–1.34, I2=0%) and 12 months (RR 1.09, 95% CI 1.01–1.18, I2=15%) were better in ROBOT than LAPA. Potency data were not available to quantitatively synthesized but all three studies which reported potency demonstrated better outcomes in ROBOT than LAPA. Conclusion: The outcomes of ROBOT were comparable to LAPA and better in continence rate and potency. For prostate cancer patients who need radical prostatectomy, the robotic surgery would be a good alternative to the conventional laparoscopic surgery
Abstract
Objectives: This study aims to compare outcomes of robot-assisted radical prostatectomy (ROBOT) with conventional laparoscopic radical prostatectomy (LAPA). Methods: Systematic searches on Medline, Embase, Cochrane library and five Korean databases were performed from January 2000 to April 2022. Randomised controlled trials (RCTs) were included and a pooled meta-analysis were conducted. The outcomes of interest included perioperative, functional, oncological and pathological outcomes, quality of life, and complications. Results: A total of five RCTs comprising 950 prostate cancer patients were included in the analysis. The total numbers of patients included in ROBOT and LAPA were 667 and 283, respectively. Overall risks of bias were low but the risk of detection bias for subjective outcomes were high. Meta-analysis showed that the operative time of ROBOT was longer than that of LAPA (mean difference [MD] 8.63 minutes, 95% confidence interval [CI] 3.28–13.98, I2=0%). The estimated blood loss was not different between ROBOT and LAPA (MD 3.98 mL, 95% CI -56.19–63.97, I2=83%) but its result was inconclusive. The surgical positive margin was higher in ROBOT but not statistically significant (risk ratio [RR] 1.38, 95% CI 1.00– 1.91, I2=0%). However, continence rates at 3 months (RR 1.16, 95% CI 1.01–1.34, I2=0%) and 12 months (RR 1.09, 95% CI 1.01–1.18, I2=15%) were better in ROBOT than LAPA. Potency data were not available to quantitatively synthesized but all three studies which reported potency demonstrated better outcomes in ROBOT than LAPA. Conclusion: The outcomes of ROBOT were comparable to LAPA and better in continence rate and potency. For prostate cancer patients who need radical prostatectomy, the robotic surgery would be a good alternative to the conventional laparoscopic surgery
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