Robotic Radical Prostatectomy superior to open surgery for Localised prostate cancer: Study

Radical prostatectomy reduces mortality among patients with localised prostate cancer. Evidence on whether different surgical techniques can affect mortality rates is lacking.

A team of researchers conducted a study to evaluate functional and oncological outcomes 8 years after robot-assisted laparoscopic prostatectomy (RALP) and open retropubic radical prostatectomy (RRP).

They enrolled 4003 patients in a prospective, controlled, nonrandomised trial comparing robot-assisted laparoscopic prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) in 14 Swedish centres between 2008 and 2011. Data for functional outcomes were assessed via validated patient questionnaires administered preoperatively and at 12 and 24 months and 8 years after surgery.

The primary endpoint was urinary incontinence. Functional outcomes at 8 yr were analysed using the modified Poisson regression approach.

The results of the study are as follows:

Urinary incontinence was not significantly different at 8 yr after surgery between robot-assisted laparoscopic prostatectomy (RALP) and open retropubic radical prostatectomy (RRP)

Erectile dysfunction was significantly lower in the robot-assisted laparoscopic prostatectomy (RALP) group

Prostate cancer-specific mortality (PCSM) was significantly lower in the robot-assisted laparoscopic prostatectomy (RALP) group at 8 yr after surgery

Differences in oncological outcomes were mainly seen in the group with high D'Amico risk, with a lower risk of positive surgical margins biochemical recurrence and PCSM for robot-assisted laparoscopic prostatectomy (RALP) versus open retropubic radical prostatectomy (RRP)

Thus, the researchers concluded that in this prospective multicentre controlled trial, PCSM at 8 yrs. after surgery was lower for robot-assisted laparoscopic prostatectomy (RALP) in comparison to open retropubic radical prostatectomy (RRP). A causal relationship between surgical technique and mortality cannot be inferred, but the result confirms that robot-assisted laparoscopic prostatectomy (RALP) is oncologically safe. Taken together with better short-term results reported elsewhere, our findings confirm that implementation of robot-assisted laparoscopic prostatectomy (RALP) may continue.

Reference:

Functional and Oncological Outcomes After Open Versus Robot-assisted Laparoscopic Radical Prostatectomy for Localised Prostate Cancer: 8-Year Follow-up by Anna Lantz published in the European Urology

https://doi.org/10.1016/j.eururo.2021.07.025