Comparing the outcomes of robot‑assisted and laparoscopic radical prostatectomy for the treatment of localized prostate cancer.

This study compared the outcomes of robotic-assisted radical prostatectomy (RARP) with standard laparoscopic radical prostatectomy (LRP) for the treatment of patients with localized prostate cancer. The study found that the RARP approach was associated with better outcomes compared to LRP.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. 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 very few studies comparing the surgical, oncological, and functional outcomes of patients undergoing RARP versus LRP.

The authors analyzed 16 studies with a total of 13,752 men with PCa. 6135 patients underwent RARP and 7617 patients underwent LRP.

The positive surgical margin (PSM; the amount of cancer cells left at the tumor site following surgery) was similar in the 2 groups. There were no significant differences in the overall and major complication rates between the 2 groups.

Biochemical recurrence (BCR) was also evaluated. If, after treatment, the prostate-specific antigen (PSA: a protein made by cells of the prostate gland) levels increased by 0.2 ng/ml from the lowest value it was considered as evidence of BCR. The BCR rate after 12 months was significantly lower (by 48%) for RARP than for LRP. 

Patients treated with the RARP approach were 62% less likely to have urinary incontinence (UI; involuntary urine leakage) compared to LRP after 12 months of treatment. After 12 months, patients treated with RARP were 2.16 times more likely to have recovered sexual function compared to the LRP approach.

This study concluded that RARP was associated with better functional and oncological outcomes compared to LRP in men with localized PCa.

Data on long-term oncological outcomes were missing. The higher cost of RARP and inexperience of many surgeons in performing this surgery compared to LRP should be considered.