Authors' objectives:

The aim of this study was to compare the safety, efficacy and costs associated with laparoscopic radical prostatectomy compared with open radical prostatectomy through a systematic assessment of the literature. A secondary objective was to assess the contribution of learning curve to efficacy outcomes.

Authors' results and conclusions: There were 21 studies comparing open and laparoscopic approaches; 13 compared transperitoneal (TLRP) to open (RRP) radical prostatectomy, three compared extraperitoneal (EERP) to open prostatectomy, and five compared robotic-assisted (RALRP) to open prostatectomy. There were nine studies comparing different laparoscopic approaches; six compared EERP and TLRP and three compared RALRP with TLRP. There were no randomised controlled trials, ten concurrently controlled comparisons (level III-2), 17 historically controlled comparisons (level III-3) and three comparisons using concurrent and historical controls (level III-2/3). In terms of safety, there did not appear to be any important differences in the complication rate between laparoscopic and open approaches, however, blood loss and transfusions were lower for the laparoscopic approaches. In terms of efficacy, operative times were longer for laparoscopic than open prostatectomy but length of stay and duration of catheterisation were shorter. There was no consistent pattern of analgesia use across the included studies. Positive margin rates were similar and there did not appear to be any important differences between laparoscopic and open prostatectomy when tumour stage or margin location were taken into consideration. Recurrence-free survival was poorly reported but did not appear to differ between the two approaches.Continence and potency were not well reported but appeared similar between the two approaches, though continence may have recovered more quickly after laparoscopic than open prostatectomy and potency may have recovered more quickly after robotic-assisted prostatectomy compared with open. Quality of life did not differ between TLRP and RRP in two studies. There were no important differences between laparoscopic approaches. Six studies reported outcomes in such a way that the effect of increasing experience with the laparoscopic approaches could be tracked. As experience with the laparoscopic approaches increased most clinical outcomes improved, including conversions to open, complications, blood loss, transfusions and operative time, but not length of hospital stay and duration of catheterization. There were no clear effects of increasing experience for positive margins rate or continence and potency outcomes.

Authors' recommendations: Laparoscopic radical prostatectomy is emerging as an alternative to open radical prostatectomy for treating localised prostate cancer. However at the present time there is insufficient comparative data regarding continence, potency and survival. There did not appear to be any clear differences between the laparoscopic approaches. A clear learning curve for laparoscopic prostatectomy was documented which affected many clinical outcomes. Although it was not possible to determine from the included studies how many laparoscopic procedures must be completed to negotiate this learning curve, the introduction of LRP should be closely monitored. Previous experience in laparoscopy and/or open radical prostatectomy is required and outcomes during the initial phase of the learning curve should be carefully documented. Recommendations: 1. a national audit of laparoscopic radical prostatectomy, including robotic-assisted LRP, should be instituted to monitor the introduction of the technique into the Australian healthcare system. 2. hospital credentialling committees should monitor the progress of surgeons introducing LRP into their practice at regular intervals, paying particular regard to rates of complications and surgical margins during the learning phase. 3. Economic evaluations taking into consideration the Australian healthcare context should be conducted.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)