Robotic versus open prostatectomy: are there differences in surgical outcomes or cancer control?

The authors evaluated the differences in surgical, cancer-related and quality of life outcomes between robot-assisted prostatectomy and retropubic prostatectomy.

Robot-assisted laproscopic radical prostatectomy has become increasingly common in prostate cancer treatment. It is a minimally invasive procedure (uses only small incisions) that relies on modern technologies such as fiber optics and miniaturization (manufacturing ever smaller mechanical and electronic devices) to surgically remove the prostate gland.

There are very few evaluations of the clinical outcomes of robot-assisted laproscopic radical prostatectomy compared to retropubic radical prostatectomy (removal of the prostate gland through a large incision in the abdomen). This study sought to establish differences in surgical, cancer-related and health-related quality of life outcomes for the two procedures.

Over a ten year period, 282 men who underwent robot-assisted prostatectomy and 621 who underwent retropubic radical prostatectomy were followed.

Among low-risk patients, 77.1% of patients who underwent retropubic prostatectomy required a lymph node dissection (surgical removal of a lymph node or group of lymph nodes) compared to 35.3% of the robot-assisted prostatectomy patients. This trend continued with intermediate-risk patients, where lymph node dissection was undertaken by 94.8% of retropubic prostatectomy patients compared to 64.8% of robot-assisted prostatectomy patients. Overall, patients in the robot-assisted prostatectomy were 82% less likely to receive lymph node dissection.

On average, robot-assisted prostatectomy patients had 495 ml less estimated blood loss during and after surgery than those who underwent retropubic radical prostatectomy. These patients were also 83% less likely to require a blood transfusion following surgery and experienced a 0.5 day average shorter stay in the hospital.

Average follow-up was 2.4 years in the robot-assisted prostatectomy group and 6.8 years in the retropubic prostatectomy group. The rate of recurrence in the robot-assisted prostatectomy group was 8.5% (all biochemical recurrences; a rise in the levels of prostate specific antigen after treatment) and 18.7% in the retropubic prostatectomy group. Among those patients with greater than 3 years of follow-up, recurrence-free survival (survival without return of the disease) was 88.9% for the robot-assisted prostatectomy patients compared to 89.9% for retropubic radical prostatectomy. Among those with greater than 5 years of follow-up, recurrence-free survival was 88% for robot-assisted prostatectomy compared to 84.7% for retropubic prostatectomy.

There were no differences in health-related quality of life outcomes between the two groups. This included urinary incontinence, urinary obstruction, sexual or bowel problems and outcome satisfaction which was 89.3% for robot-assisted prostatectomy and 89.5% for retropubic prostatectomy.

The authors state that robot-assisted laparoscopic radical prostatectomy resulted in shorter hospital stay, less blood loss, and fewer blood transfusions than radical retropubic prostatectomy. There were no differences in cancer control or health-related quality of life.