10 years on: Open prostate surgery versus robot-assisted laparoscopic prostate surgery

This study compared long-term outcomes of open prostate surgery and robot-assisted laparoscopic prostate surgery. Researchers reported similar treatment outcomes at 10 years between the two surgical approaches. 

Prostate surgery (also called radical prostatectomy) is a common treatment for localized (confined) prostate cancer. Robotic-assisted laparoscopic radical prostatectomy (RALP) is prostate surgery aided by surgical robots. This type of surgery involves multiple small incisions, rather than the one large incision used for open surgery. RALP has allowed for more precise and careful removal of the prostate with minimal damage to surrounding tissue. When compared to open surgery, RALP is associated with fewer complications and similar treatment outcomes. However, more studies are needed to establish how RALP compares to open surgery in the long term. 

This study aimed to compare the safety and effects of open prostate surgery and RALP over 10 years.

This study included 179 men undergoing prostate surgery for localized prostate cancer. 63 men underwent open prostate surgery and 116 men underwent RALP. Patients were followed for an average of 10.3 years.

The average operating time was longer with RALP (average 246 minutes) than with open surgery (average 190 minutes). However, men undergoing RALP had significantly shorter hospitals stays (1 to 2 days) compared to open surgery (2 to 3 days), as well as less blood loss during the procedure.

Men undergoing open surgery were more likely to have aggressive cancer cells (based on tissue samples) before surgery. No significant differences in disease recurrence rates were observed at 10 years between the two surgical procedures after accounting for cancer markers and tumor stage. The average time to recurrence was 95.9 months with open surgery and 117.5 months with RALP. Mortality rates from all causes and from prostate cancer were also similar between RALP and open surgery.

No significant long-term differences in erectile function and urinary continence were noted between the two surgical procedures. 41.5% of men following open surgery and 48% of RALP patients had normal erectile and ejaculatory function at 10 years. Continence rates at 10 years were 92.6% for open surgery and 95% for RALP. The effect of urinary or sexual symptoms on quality of life was comparable between the two groups.

This study concluded that long-term treatment outcomes with RALP are similar to those of open prostate surgery.

Patients in this study were recruited in 2004, which is considered early for performing RALP procedures. The surgeons in this study therefore had more experience with open prostate surgery than with RALP. Larger trials that randomly assign patients to each treatment group are needed to confirm these findings.