Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot‐assisted techniques

Abstract

OBJECTIVETo assess the perioperative complications and early oncological results in a comparative study matching open radical retropubic (RRP) and robot‐assisted radical prostatectomy (RARP) groups.PATIENTS AND METHODSFrom August 2002 to December 2005 we identified 294 patients undergoing RARP for clinically localized prostate cancer. A comparison RRP group of 588 patients from the same period was matched 2:1 for surgical year, age, preoperative prostate‐specific antigen level, clinical stage and biopsy Gleason grade. Perioperative complications were compared. Patients completed a standardized quality‐of‐life questionnaire. Pathological features were assessed and Kaplan‐Meier estimates of biochemical progression‐free survival (PFS) were compared.RESULTSThere was no significant difference in overall perioperative complications between the RARP and RRP groups (8.0% vs 4.8%, P = 0.064). Wound herniation was more common after RARP (1.0% vs none, P = 0.038), and development of bladder neck contracture was more common after RRP (1.2% vs 4.6%; P < 0.018). The hospital stay was less after RARP (29.3% vs 19.4%, P = 0.004, for a stay of 1 day). At the 1‐year follow‐up there was no significant difference in continence (RARP 91.8%, RRP 93.7%, P = 0.344) or potency (RARP 70.0%, RRP 62.8%, P = 0.081) rates. The biochemical PFS was no different between treatments at 3 years (RARP 92.4%, RRP 92.2%; P = 0.69).CONCLUSIONThere was no significant difference in overall early complication, long‐term continence or potency rates between the RARP and RRP techniques. Furthermore, early oncological outcomes were similar, with equivalent margin positivity and PFS between the groups.

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

“…In a similar study from the Mayo Clinic with a median follow-up of 16 months, the BCR rate was not different between RALP and ORP patients (8% for both, p = 0.69)[18]. Likewise, a comparative study from Duke University with mean follow-up of approximately 1 year found no difference in BCR rates between ORP and RALP after adjusting for the effects of clinical and pathologic features (hazard ratio 0.94; 95% CI: 0.55–1.61; p = 0.82)[35].…”

“…In an age- and tumor characteristic–matched comparison of 588 ORPs and 294 RALPs, researchers from the Mayo Clinic found no difference in overall complication rates[18]. One-month complication rates for the RALP group were 8% compared to 5% in the ORP group ( p = 0.064).…”

“…Krambeck et al found no difference in positive surgical-margin rates between RALP and ORP(16 vs. 17%, p = 0.61)[18]. Their study included nearly 300 RALP patients matched with almost 600 ORP patients; matching was done according to patient age, PSA, Gleason score, clinical stage, and year of surgery.…”

“…The median time to return to continence for the RALP group was 44 days compared to 160 days for the ORP group. Krambeck et al, in contrast, found no difference in urinary continence outcomes between surgical approaches[18]. On an unvalidated questionnaire, patients were considered continent if they had no urinary leakage or required only a security pad.…”

“…Krambeck et al reported no significant difference in 1-year potency rates between ORP and RALP (63 vs. 70%, p = 0.08)[18]. Potency was defined as erections satisfactory for intercourse with or without phosphodiesterase-5 inhibitors.…”