Comparison of the results of surgical treatment using various types of access in patients with prostate cancer: oncological, functional, and financial effectiveness

Prostate cancer is a very important problem in modern urologic oncology. The reason for this is a steady increase of morbidity and mortality in Russia and worldwide. Surgical treatment and hormonal/radiation therapy combination are the golden standard of radical therapy in patients with local and locally advanced prostate cancer. Vast experience has been accumulated worldwide in radical prostatectomy using various types of access: open retropubic, perineal, laparoscopic, and robot-assisted. Many studies focused on finding advantages of using minimally invasive access for this surgery, but the results are quite contradictory.

The article presents a systematic review of literature data, evaluation of the effectiveness of each access in radical prostatectomy in patients with prostate cancer.

1. Shakhzadova A.O., Starinsky V.V., Lisichnikova I.V. Cancer care to the population of Russia in 2022. Sibirskiy onkologicheskiy zhurnal = Siberian Journal of Oncology 2023;22(5):5–13. (In Russ.). DOI: 10.21294/1814-4861-2023-22-5-5-13

2. Carbonara U., Srinath M., Crocerossa F. et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol 2021;39(10):3721–32. DOI: 10.1007/s00345-021-03687-5

3. Hagman A., Lantz A., Carlsson S. et al. Urinary continence recovery and oncological outcomes after surgery for prostate cancer analysed by risk category: results from the LAParoscopic prostatectomy robot and open trial. World J Urol 2021;39(9): 3239–49. DOI: 10.1007/s00345-021-03662-0

4. Lantz A., Bock D., Akre O. et al. Functional and oncological outcomes after open versus robot-assisted laparoscopic radical prostatectomy for localised prostate cancer: 8-year follow-up. Eur Urol 2021;80(5):650–60. DOI: 10.1016/j.eururo.2021.07.025

5. Stolzenburg J.U., Holze S., Neuhaus P. et al. Robotic-assisted versus laparoscopic surgery: outcomes from the first multicentre, randomised, patient-blinded controlled trial in radical prostatectomy (LAP-01). Eur Urol 2021;79(6):750–9. DOI: 10.1016/j.eururo.2021.01.030

6. Stolzenburg J.U., Holze S., Arthanareeswaran V.K. et al. Roboticassisted versus laparoscopic radical prostatectomy: 12-month outcomes of the multicentre randomised controlled LAP-01 trial. Eur Urol Focus 2022;8(6):1583–90. DOI: 10.1016/j.euf.2022.02.002

7. Moretti T.B.C., Magna L.A., Reis L.O. Open, laparoscopic, and robot-assisted radical prostatectomy oncological results: a reverse systematic review. J Endourol 2023;37(5):521–30. DOI: 10.1089/end.2022.0819

8. Wang J., Hu K., Wang Y. et al. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Sur 2023;17(6):2617–31. DOI: 10.1007/s11701-023-01714-8

9. Ambrosini F., Knipper S., Tilki D. et al. Robot-assisted vs open retropubic radical prostatectomy: a propensity score-matched comparative analysis based on 15 years and 18,805 patients. World J Urol 2024;42(1):131. DOI: 10.1007/s00345-024-04824-6

10. Suh J., Jeong I.G., Jeon H.G. et al. Long-term oncologic outcomes of robot-assisted versus open radical prostatectomy for prostate cancer with seminal vesicle invasion: a multi-institutional study with a minimum 5-year follow-up. J Cancer Res Clin Oncol 2023;149(5):1951–60. DOI: 10.1007/s00432-022-04243-3

11. Rechtman M., Forbes A., Millar J.L. et al. Comparison of urinary and sexual patient-reported outcomes between open radical prostatectomy and robot-assisted radical prostatectomy: a propensity score matched, population-based study in Victoria. BMC Urol 2022;22(1):18. DOI: 10.1186/s12894-022-00966-0

12. Haney C.M., Kowalewski K.F., Westhoff N. et al. Robot-assisted versus conventional laparoscopic radical prostatectomy: a systematic review and meta-analysis of randomised controlled trials. Eur Urol Focus 2023;9(6):930–7. DOI: 10.1016/j.euf.2023.05.007

13. Wu S.Y., Chang C.L., Chen C.I. et al. Comparison of acute and chronic surgical complications following robot-assisted, laparoscopic, and traditional open radical prostatectomy among men in Taiwan. JAMA Netw Open 2021;4(8):e2120156. DOI: 10.1001/jamanetworkopen.2021.20156

14. Labban M., Dasgupta P., Song C. et al. Cost-effectiveness of robotic-assisted radical prostatectomy for localized prostate cancer in the UK. JAMA Netw Open 2022;5(4):e225740. DOI: 10.1001/jamanetworkopen.2022.5740

15. Song C., Cheng L., Li Y. et al. Systematic literature review of costeffectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer. BMJ Open 2022;12(9):e058394. DOI: 10.1136/bmjopen-2021-058394

16. Wu S.Y., Chang S.C., Chen C.I. et al. Latest comprehensive medical resource consumption in robot-assisted versus laparoscopic and traditional open radical prostatectomy: a nationwide population-based cohort study. Cancers 2021;13(7):1564. DOI: 10.3390/cancers13071564

17. Lindenberg M.A., Retèl V.P., van der Poel H.G. et al. Cost-utility analysis on robot-assisted and laparoscopic prostatectomy based on long-term functional outcomes. Sci Rep 2022;12(1):7658. DOI: 10.1038/s41598-022-10746-3

18. Okhawere K.E., Shih I.F., Lee S.H. et al. Comparison of 1-year health care costs and use associated with open vs robotic-assisted radical prostatectomy. JAMA Netw Open 2021;4(3):e212265. DOI: 10.1001/jamanetworkopen.2021.2265

19. Ploussard G., Grabia A., Barret E. et al. Annual nationwide analysis of costs and post-operative outcomes after radical prostatectomy according to the surgical approach (open, laparoscopic, and robotic). World J Urol 2022;40(2):419–25. DOI: 10.1007/s00345-021-03878-0

20. Ryabov M.A., Kotov S.V. Comparative assessment of the learning curve of retropubic, laparoscopic, perineal, and robot-assisted radical prostatectomy. Vestnik urologii = Urology Herald 2022;10(2):63–71. (In Russ.). DOI: 10.21886/2308-6424-2022-10-2-63-71

21. Grivas N., Zachos I., Georgiadis G. et al. Learning curves in laparoscopic and robot-assisted prostate surgery: a systematic search and review. World J Urol 2022; 40(4):929–49. DOI: 10.1007/s00345-021-03815-1

22. Chahal B., Aydin A., Amin M.S.A. et al. The learning curves of major laparoscopic and robotic procedures in urology: a systematic review. Int J Surg 2023;109(7):2037–57. DOI: 10.1097/JS9.0000000000000345