Robot-assisted radical prostatectomy for high-risk and locally advanced prostate cancer: a bibliometric and evidence-mapping analysis of oncologic safety, functional outcomes, lymph-node management, and multimodal treatment.

Robot-assisted radical prostatectomy (RARP) has become an increasingly discussed surgical option for patients with high-risk or locally advanced prostate cancer. Nevertheless, how publications, knowledge structures, and research priorities have developed in this area remains insufficiently clarified. This study aimed to characterize the bibliometric profile and clinically oriented evidence domains of RARP for this patient population, with emphasis on oncologic safety, functional outcomes, lymph-node management, and multimodal treatment. Publications were retrieved from the Web of Science Core Collection. Eligible records included English-language original articles and reviews with official publication years up to 2025. After database filtering and manual screening, 643 records were retained, including 596 original articles and 47 review articles. Bibliometric assessment, data processing, and graphical visualization were performed using R, Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica. We analyzed publication trajectories, geographic and institutional contributions, author activity, journal distribution, citation links, reference co-citation patterns, keyword networks, thematic clusters, burst keywords, and longitudinal topic changes. Scientific output increased progressively from 2003 to 2025, with publication activity becoming more pronounced in the most recent period. In terms of national contribution, the United States showed the strongest overall performance in both publication output and citation impact, whereas Italy, the Netherlands, Japan, China, and several other countries also made substantial contributions. At the institutional level, the Netherlands Cancer Institute, Vita-Salute San Raffaele University, and the University of Verona represented major contributors. BJU International, European Urology, World Journal of Urology, Journal of Endourology, and Journal of Robotic Surgery were identified as key journals for disseminating research in this area. Keyword and co-citation findings indicated a gradual transition from early surgical experience, learning-curve assessment, and technical feasibility toward research on oncologic outcomes, lymph-node management, functional recovery, and multimodal treatment, alongside increasing attention to magnetic resonance imaging, pathological grading, and predictive factors. Research activity concerning robot-assisted radical prostatectomy for high-risk and locally advanced prostate cancer has expanded consistently over the past 20 years and has progressively shifted toward an integrated clinical research framework centered on oncologic safety, functional outcomes, lymph-node management, and multimodal treatment. Diagnostic and risk-assessment themes have increasingly supported patient selection, staging, and treatment planning within this framework. Future investigations incorporating harmonized definitions, longer follow-up, prospective multicenter designs, and consistent reporting of oncologic, functional, nodal, and treatment-sequencing outcomes are needed to define more precisely the clinical role of RARP in this patient population.