Comparative functional, perioperative and oncological outcomes of robot-assisted and open radical prostatectomy: a systematic review and meta-analysis

INTRODUCTION: Robot-assisted radical prostatectomy (RARP) has increasingly replaced open radical prostatectomy (ORP) based on evidence suggesting improved perioperative outcomes and faster recovery. However, few randomized trials directly compare both techniques. This review compares perioperative, functional, and oncological outcomes of RARP versus ORP, integrating newly available high-impact studies. METHODS: A thorough search of major databases was conducted from the inception of each database up to November 2025, adhering to PRISMA guidelines. Two reviewers independently screened studies in a three-step process-titles, abstracts, and full texts. Only randomized controlled trials (RCTs) and prospective studies comparing RARP and ORP were included. All variables were entered into a spreadsheet for analysis and cross-checked. The primary endpoints assessed were perioperative complications, functional recovery (urinary continence and erectile function), and oncological outcomes. RESULTS: A total of 27 studies comprising 38,530 patients were included. Compared with ORP, RARP was associated with significantly reduced intraoperative blood loss (mean difference [MD] : - 576.78; p < 0.01), lower transfusion rates (Odds Ratio [OR] 0.27; p < 0.0001), and shorter hospital stay (MD: - 1.44 days; p < 0.0001). RARP also demonstrated fewer postoperative complications (OR 0.59; p = 0.002). Regarding functional outcomes, RARP yielded superior urinary continence recovery at 3 months and improved erectile function recovery (OR 1.43). Additionally, RARP showed a lower biochemical recurrence rate at 24 months (OR 1.34), with no significant difference observed in short-term follow-up (< 12 months). CONCLUSION: RARP offers advantages over ORP, particularly in reducing perioperative morbidity and enhancing functional recovery while maintaining comparable or superior oncological outcomes. However, further randomized controlled trials with extended follow-up are necessary to confirm these findings. KEY MESSAGES: 1. RARP was associated with significantly reduced blood loss, lower transfusion requirements, and shorter hospitalization. 2. Functional outcomes favored RARP, including superior recovery of urinary continence and higher rates of nerve-sparing preservation. 3. Overall, the evidence supports RARP as a safe, effective, and clinically advantageous approach for localized prostate cancer.