Robot-assisted radical prostatectomy compared with open radical prostatectomy: an umbrella review

Abstract Objective The objective of this umbrella review was to identify and synthesize systematic reviews comparing the clinical outcomes of robot-assisted radical prostatectomy and open radical prostatectomy. Background Robot-assisted radical prostatectomy (RARP) has emerged as a minimally invasive option, whereas retropubic radical prostatectomy (RRP) represents the traditional open surgical approach. An umbrella review of the existing systematic reviews comparing the clinical outcomes of RARP and RRP was selected as a suitable method for synthesizing the highest level of available evidence. Methods The original literature search was conducted on 28 November 2023 in MEDLINE (PubMed) and Epistemonikos to identify relevant systematic reviews. Following the peer-review process, the search was updated on 12 June 2026 using the same search strategy to identify any newly published evidence. The updated search results were combined with the records identified in the original search. In total, 738 records were identified. After removing duplicates ( n = 280), 458 records were screened. Of these, 429 were excluded. Finally, 13 systematic reviews were included in the umbrella review. Two independent reviewers (JR and TV) performed the title, abstract, full-text screening, and data extraction. A summary of the extracted data was presented in a tabular format, and a narrative synthesis was performed. Results The methodological quality of the included systematic reviews was rated as low for six reviews, moderate for five reviews, and high for two reviews. The comparison between RARP and RRP in 13 systematic reviews revealed a variable number of primary studies, ranging from 6 to 79, with most evidence coming from prospective and retrospective studies. Only a small number of randomized control trial (RCT) were identified among the primary studies included. Conclusions RARP demonstrates favorable perioperative outcomes compared with RRP, including reduced blood loss, lower transfusion rates, shorter hospital stay, and fewer overall complications, whereas operative time remains shorter with RRP. Findings regarding functional outcomes remain inconsistent across systematic reviews, although erectile function recovery may favor RARP. Oncological outcomes, including positive surgical margins and biochemical recurrence, appear broadly comparable between approaches, with a potential advantage of RARP regarding biochemical recurrence. The substantial methodological heterogeneity of available evidence highlights the need for high-quality studies focusing on long-term functional and oncological outcomes. Systematic review registration number PROSPERO [CRD42023472309].