Long-term functional outcomes after robot-assisted prostatectomy compared to laparoscopic prostatectomy: Results from a national retrospective cluster study

Abstract

Background: Despite multiple studies evaluating the effectiveness of Robot-Assisted Radical Prostatectomy (RARP), there is no definitive conclusion about the added value of RARP. A retrospective cluster study was conducted to evaluate long-term sexual and urinary functioning after RARP and Laparoscopic Radical Prostatectomy (LRP) based on real-world data from 12 Dutch hospitals. Methods: Data was collected from patients who underwent surgery between 2010 and 2012. A mixed effect model was used to evaluate differences between groups on urinary and sexual functioning (EPIC-26). Additionally, a regression analysis was conducted to evaluate the relationship between these functional outcomes and, among others, hospital volume. Results: 1370 (65.1%) patients participated, 907 underwent RARP and 463 LRP, with a median follow-up time of 7.08 years (SD ¼ 0.98). The RARP group showed a statistically and clinically significant better urinary functioning compared to the LRP group (p ¼ 0.002). RARP showed also a shorter procedure time (p¼<0.001), reduced blood loss (p¼<0.001), and a higher chance of neurovascular bundle preservation (39.8% vs 29.1%; p¼<0.01). Conclusion: RARP resulted in better long-term urinary function compared to LRP. Based on the results from this study, guidelines concerning the preferred surgery type and the position on reimbursement may change, especially when RARP proves to be cost-effective.

Ten‐year functional and oncological outcomes of a prospective randomized controlled trial comparing laparoscopic versus robot‐assisted radical prostatectomy

“…We can speculate that the robotic approach, with its enhanced visualization and mobility, allows to perform a more accurate nerve-sparing, reducing the stress and damage on the neurovascular bundles' fibers, resulting in a faster and higher rate of erection, according to Literature for the early potency (12 months) recovery. 24 However, despite the Δ8% in favor of robotics in our NS series, a significant benefit was not reached, in accordance with the experience of Lindenberg and colleagues, 26 even if the better IIEF-5 at the end of the follow-up was recorded (p < 0.001).…”

“…24 Furthermore, the benefit of the robotic approach was revealed to be significant also after 2 years of followup. 25 On the other hand, the long-term data are controversial: if a large Dutch retrospective series including 1370 patients with a median follow-up time of 7.08 years, proved the advantages of RARP versus LRP for continence recovery (p = 0.002) 26 ; on the contrary, Lantz et al did not find advantages for robotics compared to open prostatectomy in their 8 years follow-up study. 4 Similar trends were reported in our series for potency recovery in the nerve-sparing cohort.…”

Ten-Years functional and oncological outcomes of a prospective randomised controlled trial comparing laparoscopic versus robot-assisted radical prostatectomy Running title: RARP vs LRP after 10 years of follow-up

“…We can speculate that the robotic approach, with its enhanced visualisation and mobility, allows to perform a more accurate nerve-sparing, reducing the stress and damage on the neurovascular bundles bres, resulting in a faster and higher rate of erection, according to Literature for the early potency (12 months) recovery [20]. However, despite the Δ8% in favour of robotics in our NS series, a signi cant bene t was not reached, in accordance with the experience of Lindenberg and colleagues [22], even if the better IIEF-5 at the end of follow-up was recorded ((p < 0.001). Brie y, summarizing our ndings on functional outcomes, we can a rm that even if the rate of continent and potent patients in the second lustrum did not differ between the two groups, analysing the entire 10-year follow-up period, the two study cohorts differ in terms of functional performances, as highlighted by the PLS-DA analysis.…”

“…Furthermore, the bene t of the robotic approach revealed to be signi cant also after 2 years of follow-up [21]. On the other hand, the long terms data are controversial: if a large Dutch retrospective series including 1370 patients with a median follow-up time of 7.08 years, proved the advantages of RARP vs LRP for continence recovery (p = 0.002) [22]; on the contrary Lantz et al did not nd advantages for robotics compared to open prostatectomy in their 8 years follow-up study [4].…”

Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?

“…On the other hand, Nyberg et al [ 37 ] found a significant difference in erectile dysfunction in favor of robotic-assisted RPEs and Laird et al [ 38 ] observed a positive impact of robotic-assisted procedures on outcomes such as reduced blood loss and transfusion rates. Similarly, Lindenberg et al [ 39 ] found in a national retrospective cluster study including twelve Dutch hospitals that robotic-assisted RPE resulted in a higher chance of preservation of neurovascular bundles, better long-term urinary tract function, less blood loss, and shorter procedure times. Based on this study, Lindenberg et al [ 40 ] recently conducted a cost-utility analysis for robot-assisted RPE from a Dutch societal perspective.…”