{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:18:34Z","timestamp":1790875114369,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. Materials and Methods: A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). Results: A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587\u20130.869) and LRP (RR 0.672, 95% CrI 0.505\u20130.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807\u20130.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997\u20131.124; RR 0.921, 95% CrI 0.845\u20131.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047\u20131.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047\u20131.402) and LRP (RR 1.438, 95% CrI 1.191\u20131.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. Conclusions: RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications).<\/jats:p>","DOI":"10.3390\/medicina61010061","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T10:32:26Z","timestamp":1735813946000},"page":"61","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Comparison of Robot-Assisted, Laparoscopic, and Open Radical Prostatectomy Outcomes: A Systematic Review and Network Meta-Analysis from KSER Update Series"],"prefix":"10.3390","volume":"61","author":[{"given":"Do Kyung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4711-772X","authenticated-orcid":false,"given":"Young Joon","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Urology, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doo Yong","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Urology, Inha University School of Medicine, Incheon 22332, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hae Do","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Urology, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Ilsan 10380, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hyun","family":"Jeon","sequence":"additional","affiliation":[{"name":"Department of Urology, Kyung Hee University School of Medicine, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Ho","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Urology, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6010-3277","authenticated-orcid":false,"given":"Sunghyun","family":"Paick","sequence":"additional","affiliation":[{"name":"Department of Urology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3470-1767","authenticated-orcid":false,"given":"Joo Yong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"},{"name":"Division of Medical Device, Clinical Trials Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.juro.2018.01.002","article-title":"Clinically Localized Prostate Cancer: AUA\/ASTRO\/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options","volume":"199","author":"Sanda","year":"2018","journal-title":"J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.prnil.2018.04.004","article-title":"Clinical outcomes and costs of robotic surgery in prostate cancer: A multiinstitutional study in Korea","volume":"7","author":"Yun","year":"2019","journal-title":"Prostate Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1046\/j.1464-410x.2001.00115.x","article-title":"Robotically-assisted laparoscopic radical prostatectomy","volume":"87","author":"Binder","year":"2001","journal-title":"BJU Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/bju.12247","article-title":"Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: A systematic review and mixed treatment comparison meta-analysis","volume":"112","author":"Robertson","year":"2013","journal-title":"BJU Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.3349\/ymj.2016.57.5.1165","article-title":"Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis","volume":"57","author":"Seo","year":"2016","journal-title":"Yonsei Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3721","DOI":"10.1007\/s00345-021-03687-5","article-title":"Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: An evidence-based analysis of comparative outcomes","volume":"39","author":"Carbonara","year":"2021","journal-title":"World J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ (Clin. Res. Ed)."},{"key":"ref_11","unstructured":"Wells, G., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2012). The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis, Ottawa Health Research Institute."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1198\/016214505000001302","article-title":"Assessing evidence inconsistency in mixed treatment comparisons","volume":"101","author":"Lu","year":"2006","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/jrsm.1044","article-title":"Consistency and inconsistency in network meta-analysis: Concepts and models for multi-arm studies","volume":"3","author":"Higgins","year":"2012","journal-title":"Res. Synth. Methods."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1016\/j.juro.2008.01.106","article-title":"Predicting an optimal outcome after radical prostatectomy: The trifecta nomogram","volume":"179","author":"Eastham","year":"2008","journal-title":"J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.eururo.2011.01.032","article-title":"Pentafecta: A new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy","volume":"59","author":"Patel","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1159\/000481438","article-title":"Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review","volume":"100","author":"Artibani","year":"2018","journal-title":"Urol. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1016\/S0022-5347(05)67511-8","article-title":"Prostate specific antigen only progression of prostate cancer","volume":"163","author":"Moul","year":"2000","journal-title":"J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S0022-5347(17)41037-8","article-title":"The value of serum prostate specific antigen determinations before and after radical prostatectomy","volume":"141","author":"Lange","year":"1989","journal-title":"J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.juro.2009.11.039","article-title":"The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era","volume":"183","author":"Boorjian","year":"2010","journal-title":"J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.eururo.2012.08.002","article-title":"The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients","volume":"64","author":"Mauermann","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1111\/j.1464-410X.2008.07791.x","article-title":"Positive surgical margins after radical prostatectomy: Do they have an impact on biochemical or clinical progression?","volume":"102","author":"Pfitzenmaier","year":"2008","journal-title":"BJU Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1111\/j.1464-410X.2012.11371.x","article-title":"Impact of surgical margin status on prostate-cancer-specific mortality","volume":"110","author":"Chalfin","year":"2012","journal-title":"BJU Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1016\/j.juro.2010.02.017","article-title":"Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality","volume":"183","author":"Wright","year":"2010","journal-title":"J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.eururo.2013.07.039","article-title":"Positive surgical margins after radical prostatectomy: A systematic review and contemporary update","volume":"65","author":"Yossepowitch","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1111\/iju.14513","article-title":"Indocyanine green guidance improves the efficiency of extended pelvic lymph node dissection during laparoscopic radical prostatectomy","volume":"28","author":"Claps","year":"2021","journal-title":"Int. J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"489.e19","DOI":"10.1016\/j.urolonc.2022.08.005","article-title":"Free-indocyanine green-guided pelvic lymph node dissection during radical prostatectomy","volume":"40","author":"Claps","year":"2022","journal-title":"Urol. Oncol."},{"key":"ref_27","first-page":"549","article-title":"Conservative Perineal Prostatectomy: The Results of Two Years\u2019 Experience and Report of Seventy-Five Cases","volume":"41","author":"Young","year":"1905","journal-title":"Ann. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/S0022-5347(17)53012-8","article-title":"Impotence following radical prostatectomy: Insight into etiology and prevention","volume":"128","author":"Walsh","year":"1982","journal-title":"J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1001\/jama.283.3.354","article-title":"Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: The Prostate Cancer Outcomes Study","volume":"283","author":"Stanford","year":"2000","journal-title":"JAMA"},{"key":"ref_30","first-page":"71","article-title":"Erectile function after radical prostatectomy","volume":"18","author":"Mulcahy","year":"2000","journal-title":"Semin. Urol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/S0094-0143(02)00175-1","article-title":"Practical considerations in radical retropubic prostatectomy","volume":"30","author":"Lepor","year":"2003","journal-title":"Urol. Clin. N. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.eururo.2012.05.045","article-title":"Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy","volume":"62","author":"Ficarra","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/bju.13480","article-title":"Posterior musculofascial reconstruction after radical prostatectomy: An updated systematic review and a meta-analysis","volume":"118","author":"Grasso","year":"2016","journal-title":"BJU Int."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kim, J.W., Kim, D.K., Ahn, H.K., Jung, H.D., Lee, J.Y., and Cho, K.S. (2019). Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8122068"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1159\/000366008","article-title":"Retropubic, laparoscopic, and robot-assisted radical prostatectomy: Surgical, oncological, and functional outcomes: A systematic review","volume":"93","author":"Celestino","year":"2014","journal-title":"Urol. Int."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/61\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:23:42Z","timestamp":1759850622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/61"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,2]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["medicina61010061"],"URL":"https:\/\/doi.org\/10.3390\/medicina61010061","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,2]]}}}