Elsevier

Urology

Volume 91, May 2016, Pages 111-118
Urology

Laparoscopy and Robotics
Experienced Open vs Early Robotic-assisted Laparoscopic Radical Prostatectomy: A 10-year Prospective and Retrospective Comparison

https://doi.org/10.1016/j.urology.2015.12.072Get rights and content

Objective

To undertake a prospective/retrospective comparison of longer-term oncologic and quality of life outcomes in open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALP) patients.

Materials and Methods

The clinical progression of ORP and RALP patients who underwent surgery during 2004 was followed over an extended (10 year) period. Pre- and perioperative parameters, oncologic outcomes, recurrence, mortality, and quality of life were compared between surgical modalities. Follow-up time was calculated from the time of surgery to the latest contact. Postoperative quality of life data were obtained from Expanded Prostate Cancer Index Composite survey questionnaires. Recurrence rates, times to recurrence, surgical time, length of stay, hematocrit, follow-up time, and sexual and urinary bother scores were compared between surgical groups. Multivariate analyses were used to predict positive surgical margins and biochemical recurrence.

Results

63 ORP and 116 RALP patients were included (mean age of 60.4 ± 6.4 and 58.6 ± 5.8 years; P = .067), with follow-up times of 10.3 and 10.1 years (P = .191). RALP patients had longer operative times (P < .001), shorter hospital stays (P < .001), and higher discharge hematocrits (P < .001). With prostate-specific antigen, Gleason score, and T-stage as covariates, time to recurrence (P = .365) and positive margin rate (P = .230) were not statistically different between groups. Ninety-five percent of RALP patients were continent and 48.0% were potent vs 92.6% and 41.5% of ORP patients (P = .720; .497). Urinary and sexual bother were not significantly different between groups (P = .392; .985).

Conclusion

Our longer-term follow-up data suggest that ORP and RALP patients have comparable oncologic and quality of life outcomes.

Section snippets

Materials and Methods

All patients who underwent ORP or RALP procedures in 2004 at our clinical center were included. A single surgeon performed all of the ORP procedures included in this study. A different, single surgeon performed all of the RALP procedures. All patients had clinically localized disease and a life expectancy of ≥10 years. The surgical modality was selected by the patient after being counseled regarding both options. Urologic follow-up was scheduled at 1-2 weeks, then every 3 months for the first

Patient Demographics

A total of 179 patients underwent either ORP or RALP in 2004. Of these patients, 63 (35.2%) and 116 (64.8%) underwent ORP or RALP, respectively. There were no conversions from RALP to ORP. Maximal follow-up time for ORP patients was 10.3 years (interquartile range: 9.7-10.7), which was not significantly different to RALP patients (10.1 years [interquartile range: 9.6-10.5]; P = .191; Table 1). When patients who died during the study period (2004-2014) were taken into account, maximal follow-up

Discussion

Over the last decade, RALP has become more commonplace in the United States.20 Previously reported outcome studies indicate RALP patients experience less surgical blood loss, fewer blood transfusions, shorter length of hospital stay, and improved surgical margin status compared with ORP patients.6, 11, 12, 21 However, less is established regarding comparative longer-term outcomes of ORP and RALP.

Comparable recurrence rates and recurrence-free survival between RALP and ORP patients at 5-year

Conclusion

Oncologic outcome, urinary and sexual function, and mortality are comparable between ORP and RALP patients over an extended follow-up period. Our data support conclusions drawn from previous shorter-term outcome studies and endorse the equanimity between RALP and ORP.

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

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