Laparoscopic radical prostatectomy versus robot-assisted radical prostatectomy: comparison of oncological outcomes at a single center

Okegawa, Takatsugu; Omura, Shota; Samejima, Mio; Ninomiya, Naoki; Taguchi, Satoru; Nakamura, Yu; Yamaguchi, Tsuyoshi; Tambo, Mitsuhiro; Fukuhara, Hiroshi

doi:10.1016/j.prnil.2019.09.004

Cited by 14 publications

(8 citation statements)

References 32 publications

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“…LRP has rapidly emerged as an alternative to open RP, with the advantage of reducing blood loss and length of hospital stay ( 1 , 11 ). Subsequently, with the superiority of robotic surgical platforms in providing a three-dimensional magnified visualization of the surgical field, improved dexterity, and high precision, RARP is generally considered an excellent evolution of minimally invasive surgery to address the difficulties inherent in complex laparoscopic surgery ( 12 ) and has been widely adopted for localized PCa since 2001 ( 13 – 15 ). However, given the prohibitively high cost of robotic systems and the scarcity of scientific evidence supporting the benefits of RARP over LRP, LRP is still routinely performed for localized PCa in many centers across Europe and Asia ( 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

Deng

Liu

et al. 2021

Front. Oncol.

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ObjectiveWe aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up.Materials and MethodsPatients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups.ResultsAll operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively).ConclusionsFor surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.

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Section: Introductionmentioning

confidence: 99%

Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

Deng

Liu

et al. 2021

Front. Oncol.

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“…With the superiority of surgical robots in a three-dimensional magnified vision of the surgical field, improved dexterity, and high precision during the surgical procedure, robot-assisted RP (RARP) is considered a great evolution of minimally invasive surgery to reduce the difficulty associated with complex laparoscopic surgery [ 12 ], and it has been widely disseminated for localized PCa since 2001 [ 13 ]. However, given the prohibitively high cost of robotic systems and the scarcity of scientific evidence supporting RARP over laparoscopic RP (LRP), the latter was still routinely performed for localized PCa at many centers in Europe and Asia [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, given the prohibitively high cost of robotic systems and the scarcity of scientific evidence supporting RARP over laparoscopic RP (LRP), the latter was still routinely performed for localized PCa at many centers in Europe and Asia [ 14 , 15 ]. Furthermore, thus far, whether the advantage of RARP over LRP mentioned above could translate into superior functional preservation and oncological control remains inconclusive due to the scarcity of high-level evidence comparing RARP and LRP for localized PCa [ 12 , 16 ]. Only three randomized controlled trials concentrated on comparing RARP and LRP for localized PCa, with different endpoints over short-term study periods [ 17 – 19 ], which is far from reaching a convincing consensus about the controversy.…”

Section: Introductionmentioning

confidence: 99%

Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

Deng

Chen

Zhu

et al. 2021

Journal of Oncology

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Aim. To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods. 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results. Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group ( p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group ( p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group ( p = 0.192 and p = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up ( p = 0.013 and p = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups ( p = 0.228). Conclusions. For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.

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“…However, thus far, whether the advantages of RARP over laparoscopic RP (LRP) mentioned above could translate into superior functional preservation and oncological control was still inconclusive due to the scarcity of high-level evidence comparing RARP and LRP for localized PCa (10,12). There are only three randomized controlled trials (RCTs) concentrating on comparing RARP and LRP for localized PCa with different endpoints over the short-term study periods (13)(14)(15), which is far from reaching a convincing consensus about the controversy.…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

Dong

Zhang

Hao

et al. 2021

Preprint

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Background To evaluate the functional and oncological efficacy of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for immediate- and high-risk localized prostate cancer (PCa). Methods 232 patients bearing immediate- and high-risk localized PCa between January 2016 and October 2019 were enrolled according to the inclusion criteria. The perioperative, functional and oncological outcomes were compared between the RARP and LRP groups after applying the propensity-score matching (PM) (1:1) method, which were employed to attenuate the impact of the potential baseline confounders. Results In all, except for 10 patients without a suitable pair, the remaining patients in the LRP group were successfully matched to 85 patients in the RARP arm. All differences in preoperative variables turned to be insignificant after PM. Within the matched cohort, no open conversion was required in both groups. The RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to that in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the mean estimated blood loss, rates of pT3 disease and positive surgical margin, median specimen Gleason score and hospital stay length existed between the two groups. RARP vs. LRP tended to a significantly higher percentage of urinary continence at the removal of catheter (p = 0.031), postoperative 6 months (p = 0.043), and last follow-up (p = 0.046). Significant differences were also found between the RARP and LRP arms in erectile function at postoperative 6 months and last follow-up (p = 0.013 and p = 0.009, respectively). The statistical comparability between the two groups was observed in biochemical recurrence-free survival (p = 0.228). Conclusions For surgically managing immediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised when comparing with LRP.

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Laparoscopic radical prostatectomy versus robot-assisted radical prostatectomy: comparison of oncological outcomes at a single center

Cited by 14 publications

References 32 publications

Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

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