Comparative analysis of perioperative outcomes in radical prostatectomy: laparoscopic versus robot-assisted techniques

Introduction: Robot-assisted radical prostatectomy (RARP) is a technological evolution of laparoscopic radi cal prostatectomy (LRP) and have been compared using different levels of evidence. However, most studies were based on retrospective analyses and debatable levels of evidence. This review aimed to apply a new methodology called Reverse Systematic Review to compare perioperative outcomes between LRP and RARP by critical subgroup analysis. Methods: A systematic search for Systematic Review (SR) from 01/01/2000 to 05/12/2020 on radical pros tatectomy was performed. From 80 eligible SR’s, all 910 studies included in these reviews were cataloged in a database called EVIDENCE. For this study, a subgroup analysis of 34 studies that compared perioperative out comes between LRP and RARP was performed. Results: Thirty-four studies were included for analysis regarding 6,450 patients undergoing LRP and 6,280 patients undergoing RARP. The preoperative clinical characteristics were similar. RARP was, on average, 30 minutes shorter than LRP. Estimated blood loss of LRP is, on average, 180 mL higher than RARP, resulting in a transfusion rate more than twice as high in LRP, without impacting conversion rates, length of stay and cath eter time. Regarding complication rates, there is a higher overall rate in LRP, at the expense of minor complica tions, specifically Clavien 1, but without repercussions on major ones. Conclusion: RARP presented a shorter operative time, bleeding rate, transfusion and minor complication rates than LRP, but without a clinically significant impact on major complication rates. The heterogeneity generated by the EVIDENCE database and the population-based nature increase the representativeness of the results in different clinical scenarios, but caution should be taken when comparing with more specific conditions. Keywords: Prostate cancer, radical prostatectomy, robotic, laparoscopic, perioperative outcomes, systematic review