Robotic-assisted Versus Laparoscopic Surgery: Outcomes from the First Multicentre, Randomised, Patient-blinded Controlled Trial in Radical Prostatectomy (LAP-01)

Stolzenburg, Jens‐Uwe; Holze, Sigrun; Neuhaus, Petra; Kyriazis, Iason; Minh, Hoang; Dietel, Anja; Truß, Michael C.; Grzella, Corinn I.; Teber, Doğu; Hohenfellner, Markus; Robert, René; Albers, Peter; Mende, Meinhard

doi:10.1016/j.eururo.2021.01.030

Cited by 71 publications

(66 citation statements)

References 14 publications

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“…Surgical approach to RP should be tempered with critical signi cance of cancer control, especially when managing immediate-and high-risk PCa. Consistent with the results reported in published analyses (13,14,25), no signi cant difference in PSM rate was discovered in our study comparing RARP (17.6%) and LRP (24.7%) for immediate-and high-risk PCa. Evaluated BMI and large prostate volume were considered as the independent predictors of PSMs in men with organ-con ned PCa (26), and cumulative evidences revealed that margin status following RP was related to surgical experience (26,27).…”

Section: Discussionsupporting

confidence: 92%

“…However, these advantages mentioned above may be restricted by the higher rate of ePLNDs underwent in the RARP group which was associated with the occurrences of symptomatic lymphocele, the most frequent > Grade II complication in our study, thus resulting in similar rates of > Grade II postoperative complications. The comparability of the incidence rates of postoperative > Grade II complications between the two groups in our analysis was consistent with those reported in the contemporary series (14,(20)(21)(22)(23)(24) comparing RARP and LRP, demonstrating the similar operative safety of RARP and LRP for immediate-and high-risk PCa in experienced hands.…”

Section: Discussionsupporting

confidence: 89%

“…Intriguingly, most of these decisive factors including Gleason score and preoperative PSA were the basis of D'Amico risk classi cations, namely, the clinical endpoints, such as clinical recurrence rates, largely relied on preoperative baseline characteristics rather than PSMs after RP. In alignment with other series (14,25) comparing RARP and LRP, the similarity in the BCR-free survivals obtained after RARP and LRP was still existing, corroborating the equivalent potency of the two procedures in cancer control even when managing immediate-and high-risk PCa.…”

Section: Discussionsupporting

confidence: 71%

“…However, thus far, whether the advantages of RARP over laparoscopic RP (LRP) mentioned above could translate into superior functional preservation and oncological control was still inconclusive due to the scarcity of high-level evidence comparing RARP and LRP for localized PCa (10,12). There are only three randomized controlled trials (RCTs) concentrating on comparing RARP and LRP for localized PCa with different endpoints over the short-term study periods (13)(14)(15), which is far from reaching a convincing consensus about the controversy. What's worse, no study focusing on comparing RARP and LRP for patients with immediate-and high-risk localized PCa has been reported yet, while the cogent evidence comparing the e cacy and safety of RARP and LRP for immediate-and high-risk localized PCa is of great clinical importance.…”

Section: Introductionmentioning

confidence: 99%

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Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

Dong

Zhang

Hao

et al. 2021

Preprint

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Background To evaluate the functional and oncological efficacy of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for immediate- and high-risk localized prostate cancer (PCa). Methods 232 patients bearing immediate- and high-risk localized PCa between January 2016 and October 2019 were enrolled according to the inclusion criteria. The perioperative, functional and oncological outcomes were compared between the RARP and LRP groups after applying the propensity-score matching (PM) (1:1) method, which were employed to attenuate the impact of the potential baseline confounders. Results In all, except for 10 patients without a suitable pair, the remaining patients in the LRP group were successfully matched to 85 patients in the RARP arm. All differences in preoperative variables turned to be insignificant after PM. Within the matched cohort, no open conversion was required in both groups. The RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to that in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the mean estimated blood loss, rates of pT3 disease and positive surgical margin, median specimen Gleason score and hospital stay length existed between the two groups. RARP vs. LRP tended to a significantly higher percentage of urinary continence at the removal of catheter (p = 0.031), postoperative 6 months (p = 0.043), and last follow-up (p = 0.046). Significant differences were also found between the RARP and LRP arms in erectile function at postoperative 6 months and last follow-up (p = 0.013 and p = 0.009, respectively). The statistical comparability between the two groups was observed in biochemical recurrence-free survival (p = 0.228). Conclusions For surgically managing immediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised when comparing with LRP.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

Dong

Zhang

Hao

et al. 2021

Preprint

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“…At 3 month the continence rates were 54% for RARP and 46% for LPR. Reported erections sufficient for intercourse were 18% in patients undergoing RARP and 6.7% in LPR patients demonstrating a significant benefit in early potency recovery as well, while oncological and morbidity outcomes were similar (62). Likewise, in a small randomized, single-center RARP yielded better functional results compared to LRP throughout the 5 year follow up (63).…”

Section: Surgical Techniquementioning

confidence: 86%

Radical Prostatectomy: Sequelae in the Course of Time

et al. 2021

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Objective: Radical prostatectomy (RP) is a frequent treatment for men suffering from localized prostate cancer (PCa). Whilst offering a high chance for cure, it does not come without a significant impact on health-related quality of life. Herein we review the common adverse effects RP may have over the course of time.Methods: A collaborative narrative review was performed with the identification of the principal studies on the topic. The search was executed by a relevant term search on PubMed from 2010 to February 2021.Results: Rates of major complications in patients undergoing RP are generally low. The main adverse effects are erectile dysfunction varying from 11 to 87% and urinary incontinence varying from 0 to 87% with a peak in functional decline shortly after surgery, and dependent on definitions. Different less frequent side effects also need to be taken into account. The highest rate of recovery is seen within the first year after RP, but even long-term improvements are possible. Nevertheless, for some men these adverse effects are long lasting and different, less frequent side effects also need to be taken into account. Despite many technical advances over the last two decades no surgical approach can be clearly favored when looking at long-term outcome, as surgical volume and experience as well as individual patient characteristics are still the most influential variables.Conclusions: The frequency of erectile function and urinary continence side effects after RP, and the trajectory of recovery, need to be taken into account when counseling patients about their treatment options for prostate cancer.

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Robotic, Laparoscopic, and Open Radical Prostatectomy—Is the Jury Still Out?

Howard

2021

JAMA Netw Open

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Elsewhere in JAMA Network Open, Wu and colleagues 1 present a novel analysis of a Taiwanese national database comparing the perioperative and long-term functional outcomes of men undergoing radical prostatectomy (RP) via an open (ORP), laparoscopic (LRP), or robotic-assisted (RARP) surgical approach. Compared with ORP and LRP, RARP was associated with improvements in both immediate postoperative outcomes (ie, length of stay, blood loss, and pain) and long-term functional outcomes (ie, erectile dysfunction, urinary incontinence, and hernia). Notably, this is one of only a few studies to compare the 3 major approaches side by side, and to my knowledge, the first to do so in a majority East Asian population.

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Robotic-assisted Versus Laparoscopic Surgery: Outcomes from the First Multicentre, Randomised, Patient-blinded Controlled Trial in Radical Prostatectomy (LAP-01)

Cited by 71 publications

References 14 publications

Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

Robot-Assisted vs. Laparoscopic Radical Prostatectomy for Immediate- and High-Risk Localized Prostate Cancer: A Propensity-Score Matched Analysis

Radical Prostatectomy: Sequelae in the Course of Time

Robotic, Laparoscopic, and Open Radical Prostatectomy—Is the Jury Still Out?

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