A prospective, non‐randomized trial comparing robot‐assisted laparoscopic and retropubic radical prostatectomy in one European institution

Abstract

RESULTSWe enrolled 105 patients in the RRP and 103 in the RALP group; the two groups were comparable for all clinical and pathological variables, except median age. For RRP and RALP the respective median operative duration was 135 and 185 min ( P < 0.001), the intraoperative blood loss 500 and 300 mL ( P < 0.001) and postoperative transfusion rates 14% and 1.9% ( P < 0.01). There were complications in 9.7% and 10.4% of the patients ( P = 0.854) after RRP and RALP, respectively; the positive surgical margin rates in pT2 cancers were 12.2% and 11.7% ( P = 0.70). For urinary continence, 41% of patients having RRP and 68.9% of those having RALP were continent at catheter removal ( P < 0.001). The 12-month continence rates were 88% after RRP and 97% after RALP ( P = 0.01), with the mean time to continence being 75 and 25 days ( P < 0.001), respectively. At the 12-month follow-up, 20 of 41 patients having bilateral nerve-sparing RRP (49%) and 52 of 64 having bilateral nerve-sparing RALP (81%) ( P < 0.001) had recovery of erectile function. CONCLUSIONS

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

“…The difference in 1-year complications between the groups was primarily due to the significantly higher rate of bladder neck contractures in the ORP group (5 vs. 1%, p = 0.018). In a prospective study of 103 RALP and 105 ORP patients (study period: 2006–2007), Ficarra et al also found similar complication rates[19]. The 30-day unadjusted complication rate for RALP was 10% compared to 11% for ORP ( p = 0.85).…”

“…Similarly, Schroeck et al from Duke University reported no difference in the positive surgical-margin rate of 362 RALP patients and 435 ORP patients (29 vs. 28%, p = 0.7)[35]. In a single-institution study, Ficarra and colleagues also found no difference in the positive surgical-margin rates between RALP and ORP (34 vs. 30%, p = 0.97)[19]. In their subset analysis of patients with pathologic organ-confined disease, the rate of surgical-margin positivity was the same for both groups (12%).…”

“…In a more recent comparison from the same institution, Kordan et al reported a median EBL of 450 ml in the ORP group compared to 100 ml in the RALP group ( p < 0.001)[24]. Multiple other single-institution series have shown lower EBL in patients treated with RALP than in those treated with ORP[19,21,25,26,27,28]. To our knowledge, no study has demonstrated lower EBL in patients treated with ORP compared to RALP.…”

“…This goal has been termed the “trifecta”[36]. Unfortunately, comparative data for functional outcomes between RALP and ORP are scarce and, to our knowledge, only one study utilized validated instruments to characterize urinary continence and potency after RALP[19]. The lack of uniformity in how functional outcomes are defined and the varying methodology of data collection and analysis further complicate all functional outcome comparisons between RALP and ORP.…”

“…In their prospective, nonrandomized comparative trial, Ficarra et al found better urinary-continence results for RALP patients compared to ORP patients[19]. Using the International Consultation on Incontinence Questionnaire – Urinary Incontinence (ICIQ-UI) short form, these authors reported 12-month continence rates of 97% for RALP and 88% for ORP ( p = 0.001).…”