Comparative study of laparoscopic radical prostatectomy and robot‐assisted radical prostatectomy on perioperative, oncological and functional outcomes

Abstract

Aim The aim of the present study was to evaluate the perioperative, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) and robot‐assisted radical prostatectomy (RARP) performed at our centres. Patients and Methods All LRP and RARP performed from January 2011 to June 2016 were reviewed through electronic patient records. The preoperative cancer characteristics, perioperative parameters, pathology, oncological and functional outcomes were studied. Results A total of 136 men were included in the analysis. RARP had a significantly less estimated blood loss (933 mL vs 361 mL, P < 0.01) than LRP. Positive surgical margins were noted in 42.6 and 35.2 per cent for LRP and RARP. Four‐year biochemical recurrence‐free survival was 79.4 per cent. There were no difference across the two groups. The 3‐, 12‐, 24‐ and 36‐month continence rates were 51.6, 86.8, 86.6 and 84.6 per cent, respectively. Early continence was better in RARP. The Urogenital Distress Inventory‐6 was significantly lower for RARP at 6 weeks and 3 and 12 months, while the Incontinence Impact Questionnaires‐7 was lower for RARP at 6 weeks and at 3 months. The 3‐, 12‐, 24‐ and 36‐month erection sufficient for intercourse (ESI) rates were 11.6; 25.5; 28.4 and 21.4 per cent, respectively. More men achieved ESI after 12 months in RARP. The International Index of Erectile Function 5‐item version score was higher in RARP from 12 months onwards. Conclusion RARP appears to be a promising approach for greater minimally‐invasive benefit and functional outcome, without jeopardizing oncological control.

Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies

“…The quality assessment of the included non-randomised studies according to the NOS is elucidated in Table S2, Supplemental Digital Content 3, http://links.lww.com/JS9/A366 . It showed that 12 of the 42 included studies had seven stars 35 , 37 , 39 , 44 , 49 , 53 , 57 , 59 , 60 , 63 , 67 , 68 , 20 had eight stars 30 , 32 – 34 , 40 – 43 , 46 , 48 , 50 – 52 , 54 , 61 , 62 , 64 , 66 , 69 , 70 , and 10 had nine stars 29 , 31 , 36 , 38 , 45 , 47 , 55 , 56 , 58 , 65 .…”

“…In addition, several previous studies suggested that surgical technique might also affect functional recovery of patients after surgery 31 , 47 , 50 . They believed that compared with LRP, the robotic platforms had the advantages of improved surgical vision and increased precision for preserving of neurovascular structures, which could greatly improve functional recovery after RARP.…”

Radical prostatectomy for prostate cancer: Hong Kong status in the era of Surgical Outcomes Monitoring and Improvement Programme

“…b Definition: 0 pad, Yip et al 21 and this paper; 1 pad or less, Lo et al 20 and Cheng et al 22 Abbreviations: NA, not available; PSA, prostate-specific antigen; RALRP, robot-assisted laparoscopic radical prostatectomy.…”

“…At the time of this writing, three papers evaluating RALRP in Hong Kong were published. [20][21][22] Concerning the issue as to whether there was any improvement in outcomes throughout the years for RALRP since its first introduction in 2005, the papers by Lo et al 20 and Yip et al 21 covering the early RALRP period (2005 to 2009) were compared with that by Cheng et al 22 and ours covering the later period (2009 to 2017). The various key outcomes were compared and summarized in Table 7.…”