Prostatectomie radicale laparoscopique robot-assistée : quelles sont les preuves à l'heure d'une demande de nomenclature spécifique ?

Abstract

Introduction Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities. Material and methods A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected. Results There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP. Conclusion RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.