Robotic-Assisted versus Open Radical Prostatectomy for Localized Prostate Cancer: A Systematic Review of Oncologic and Functional Outcomes

Abstract

Introduction: Radical prostatectomy is a definitive treatment for localized prostate cancer. Robotic-assisted radical prostatectomy (RARP) has largely replaced the traditional open radical prostatectomy (ORP). This systematic review compares the long-term oncologic control and functional outcomes (urinary continence and erectile function) of these two surgical approaches.

Methods: A comprehensive search of MEDLINE, Embase, and the Cochrane Library was conducted for randomized controlled trials (RCTs) and large comparative cohort studies. Studies comparing RARP to ORP in men with localized prostate cancer were included. Primary outcomes were biochemical recurrence-free survival, and rates of urinary continence and erectile function recovery at 12 months.

Results: The meta-analysis of numerous studies showed no significant difference in biochemical recurrence-free survival between RARP and ORP. RARP was consistently associated with less intraoperative blood loss, lower transfusion rates, and shorter hospital stays. Some studies reported a modest but statistically significant faster return to urinary continence with RARP, while erectile function recovery was highly dependent on surgeon experience for both techniques.

Discussion: The main advantages of RARP are related to its minimally invasive nature, which facilitates a faster postoperative recovery. While oncologic control is equivalent to the open approach, the potential for improved early functional outcomes is an important factor. Surgeon volume and experience remain critical predictors of success for both approaches.

Conclusion: Robotic-assisted radical prostatectomy offers equivalent oncologic control to the open approach, with the established benefits of minimally invasive surgery.