Open, Laparoscopic, Retropubic, or Robotic? A Network Meta-Analysis of Post-Prostatectomy Oncologic Outcomes and Health-Related Quality of Life in Localized Prostate Cancer Patients
In brief
Robotic prostatectomy ranked best for cancer outcomes, nonrobotic for quality of life
In a network meta-analysis of 33 studies and nearly 70,000 patients, robotic surgery ranked highest for avoiding cancer recurrence and positive surgical margins. Nonrobotic approaches ranked better on specific quality-of-life measures, including incontinence, pad use and erectile dysfunction. These are ranking estimates, not proof one approach is superior; randomized trials are still needed.
- Journal
- Asian Pacific journal of cancer prevention : APJCP (Q2)
- Published
- 1 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Revina Maharani, Manarul Iman Alfafa Rachman, Putra Mahakarya Dewa, Michelle Gunawan, Kartika Taufani Sukarno, Besut Daryanto
- PMID
- 42808404
- DOI
- 10.31557/APJCP.2026.27.9.3355
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 4 October 2026).
Abstract
OBJECTIVE: Prostatectomy remains a standard surgical treatment for localized prostate cancer, a malignancy with substantial global incidence and clinical impact in men. Its rapid adoption of surgical modalities has outpaced supporting evidence, resulting in limited consensus in reporting HRQoL and oncologic outcomes. This paper aims to compare the oncologic and Health-Related Quality of Life (HRQoL) outcomes of open (ORP), retropubic (RRP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer. METHODS: A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, and grey literature for randomised controlled trials and comparative studies was performed from database inception to November 2025. Risk of bias was assessed using RoB 2.0 and ROBINS-I. A network meta-analysis evaluated oncological outcomes that consist of Biochemical Recurrence (BCR) and Positive Surgical Margins (PSM), and HRQoL metrics including urinary incontinence and erectile dysfunction. Ranking probabilities were estimated using Surface Under the Cumulative Ranking (SUCRA) values. RESULT: Thirty-three studies that met the inclusion criteria were included involving 69986 patients. Overall risk of bias for both randomized and observational studies was low. RARP ranked highest for oncologic outcomes, demonstrating the greatest likelihood of minimizing BCR (SUCRA 84.2%; 14 trials, 17,932 patients) and PSM (SUCRA 93%; 29 trials, 38,509 patients). For HRQoL, non-robotic techniques were favored across specific domains: ORP showed a 76% probability of fewer urinary incontinence events; LRP demonstrated an 87% likelihood of requiring fewer pad changes; and RRP demonstrated a 95% probability of being the best-tolerated technique regarding postoperative erectile dysfunction. CONCLUSION: RARP appears as the most favourable oncological outcome, whereas non-robotic approaches showed advantages in HRQoL domains. Future randomized trials are needed to prove the superiority of the techniques.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.