There is currently a trend towards robot-assisted laparoscopic radical prostatectomy (RALP) as opposed to open radical prostatectomy (ORP) despite ongoing debates about oncological outcomes in patients treated for prostate cancer (PCa). Several papers have compared both surgical approaches but available data were frequently affected by several factors resulting from significant heterogeneity in subjects examined (for example case mix and surgeons’ experience). The authors in this study have compared two groups of patients who had one or other of the surgical interventions (RALP vs. ORP) between 2007 and 2010 performed by four highly experienced surgeons eliminating the effect of the learning curve. Outcome variables studied include positive margins rate and biochemical recurrence (BCR). Data from over 1400 patients with no important difference in preoperative characteristics were retrospectively collected, two thirds had ORP. Majority (>80%) had pathological Gleason score of seven and above with just over one third with at least T3 disease. Positive margins were similar in both groups (15%). After stratification, margin positivity was lower in the ORP patients with low-risk disease and higher in high-risk disease within the same group. T staging did not seem to have an effect in margin positivity rate between the two groups. The study had a short median follow-up of 12 months in the ORP group and less than a year in the RALP group during which the adjusted risk of BCR was not significantly different between ORP (4.1%) as opposed to RALP (3.3%). The two-year probability of BCR was more noticeable between surgeons rather than technique. With the last conclusion, this study implies that RALP should also be considered in high-risk disease provided the operation is ‘performed optimally’. In this retrospective study, the authors emphasise the importance of the surgeon’s confidence and skill over the surgical approach in achieving ‘appropriate and complete’ operation. This study, however, has some confounding factors limiting its strength including the short follow-up. Furthermore, it did not clarify the pattern of BCR as to whether it is associated with metastasis or local recurrence.
Open radical prostatectomy vs. robotic prostatectomy: early oncological outcome
Reviewed by Ayman Younis
A case-mix-adjusted comparison of early oncological outcome of open and robotic prostatectomy performed by experienced high volume surgeons.
