Comparing outcomes after robot‑assisted and laparoscopic prostate surgery for patients with localized prostate cancer with a large prostate volume.

This study compared the surgical, functional, and oncological outcomes of robotic-assisted radical prostatectomy (RARP) with standard laparoscopic radical prostatectomy (LRP) for the treatment of patients with localized prostate cancer (PCa) with a large prostate volume. The study found that RARP was associated with better surgical, functional, and oncological outcomes compared to LRP in these patients.

Localized PCa is a form of cancer that has not spread beyond the prostate gland. Localized PCa can be treated by surgery, radiation, or hormone therapy. 

Standard LRP is a type of prostate surgery in which the prostate is removed by making small incisions. RARP is another type of prostate surgery that uses robotic hands to remove the prostate gland with more precision. Patients who undergo this surgery commonly have less blood loss and shorter hospital stays. However, there are few studies comparing the surgical, functional, and oncological outcomes of patients undergoing RARP versus LRP with a large prostate volume (PV; ≥50 ml).

This study involved 231 patients with localized PCa and large PV. Patients were divided into two groups. 126 patients underwent RARP. 105 patients underwent LRP. The average follow-up time for the RARP group was 36.8 months and for the LRP group was 32.8 months.

The average time of the surgery was significantly shorter in the RARP group (139.4 mins) compared to the LRP group (159 mins). The average blood loss was also significantly lower in the RARP group (124.2 ml) compared to the LRP group (157.3 ml).

Patients in the RARP group had significantly lower risks of complications after surgery compared with those in the LRP group. The average hospital cost was significantly higher in the RARP group (US $6950) compared with the LRP group (US $4533).

There were no significant differences in terms of positive surgical margin (cancer cells left behind at the tumor site after surgery), positive lymph node (presence of cancer cells in the lymph node), Gleason score, and the average length of hospital stay after surgery between the two groups.

48.4% of patients in the RARP group achieved immediate urinary continence (UC; ability to control urine without leakage) compared with 33.3% in the LRP group. After 3 months, UC rates were 65.1% in the RARP group compared with 50.5% in the LRP group. After 24 months, UC rates were 90.5% in the RARP group compared with 81% in the LRP group.

The erectile function (EF) or potency rate at 24 months was significantly higher for the RARP group (42.1%) compared to the LRP group (28.6%). The RARP approach was associated with better EF scores at 6 and 24 months than the LRP approach.

This study concluded that RARP was associated with better surgical, functional, and oncological outcomes compared to LRP in patients with PCa with a large prostate volume.

The study looked back in time for medical records. The study population was small. Further studies at different institutions with larger sample sizes and longer follow-up periods are required to validate the conclusions.