Decision regret after robot-assisted radical prostatectomy: A systematic review and meta-analysis

Abstract

Objective: Robot-assisted radical prostatectomy (RARP) is the most commonly performed surgical treatment for prostate cancer. However, decision regret (DR) represents a concern for both patients undergoing the procedure and clinicians involved in therapeutic management. To address this need, we performed a systematic review exploring DR severity and its associations after RARP. Methods: A comprehensive search in scientific literature databases (PubMed, Embase, Scopus, and Web of Science) identified studies on DR in RARP-treated patients. All studies objectively evaluating DR were included. Within studies using the validated 5-item DR scale (range 0-100), the pooled estimate was calculated using fixed- and random-effects models accounting for different follow-ups. A qualitative synthesis analyzed the impact of multiple baseline, perioperative, and postoperative factors on DR. Results: We retrieved 493 articles using our search strategy, with 15 meeting inclusion criteria. A total of 3480 prostate cancer patients with objective DR assessment after RARP were identified. The median follow-up ranged from 4.8 months to 6.3 years while response rates varied between 45% and 100%. Among the included studies, 10 used the Decision Regret Scale, with a pooled mean estimate of 15.22 (95% confidence interval 11.52-18.93) under the random-effects model. In the remaining five studies, DR was generally low (65%-75%) and even absent in some (12%-49%). Functional outcomes, such as continence and potency, were the most frequently reported factors significantly associated with DR. However, variability in assessing DR and other outcomes limits the ability to draw definitive conclusions. Conclusion: Most patients report low DR after RARP. Functional outcomes correlate with DR, but the heterogeneity in assessments and reporting methods warrants the need for more standardized evaluation.