Radical Prostatectomy Technique Dispute: Analyzing Over 1.35 Million Surgeries in 20 Years of History.

Autor: Moretti TBC; UroScience and Department of Urology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil; Doctoral Program in Medical Pathophysiology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil., Magna LA; Department of Genetics, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil., Reis LO; UroScience and Department of Urology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil; Doctoral Program in Medical Pathophysiology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil; Urologic Oncology Department, School of Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brazil. Electronic address: reisleo.l@gmail.com.
Jazyk: angličtina
Zdroj: Clinical genitourinary cancer [Clin Genitourin Cancer] 2023 Aug; Vol. 21 (4), pp. e271-e278.e42. Date of Electronic Publication: 2023 Feb 16.
DOI: 10.1016/j.clgc.2023.02.005
Abstrakt: 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 (n r  = 752, 43.7% for RARP; n r  = 559, 32.4% for RRP; n r  = 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%, n r  = 468) and Asia (47.8%, n r =129), while LRP predominate in Europe (42.3%, n r =230) and RRP in Oceania (45.1%, n r  = 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.
Competing Interests: Disclosure Reis LO is supported by research funding from J. William Fulbright Foreign Scholarship and Brazilian National Council for Scientific and Technological Development – CNPq, Research Productivity: 304747/2018-1 and 310135/2022-2. The funder was not involved in study design, data collection, data analysis, manuscript preparation, and/or publication decisions. The authors report no conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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