Robotic Prostate Cancer Surgery Has Advantages

Blood loss is reduced and hospital stays are shorter compared with RRP.
Blood loss is reduced and hospital stays are shorter compared with RRP.

Robot-assisted laparoscopic radical prostatectomy (RALP) is associated with improved perioperative parameters, such as less blood loss and shorter hospital stays, compared with open retropubic radical prostatectomy (RRP), but oncologic outcomes are similar, according to the findings of a recently published study.

The study, by Mehrdad Alemozaffar, MD, of Keck Medical Center at the University of Southern California in Los Angeles, and colleagues included 903 men diagnosed with prostate cancer (PCa) from 2000 to 2010 and underwent radical prostatectomy using RALP (282 patients) or RRP (621 patients). The study subjects were participants in the Health Professionals Follow-up Study (HPFS), a prospective study that enrolled 51,529 U.S. male health professionals in 1986.

In the current study, the median follow-up time was 2.4 years for the RALP group and 6.8 years for the RRP group.

Among patients with low-risk and intermediate-risk disease, those who underwent RALP were significantly less likely than RRP patients to have a lymph node dissection (35.3% vs. 77.1% and 64.8% vs. 94.8%, respectively), Dr. Alemozaffar's group reported online ahead of print in European Urology. RALP patients had significantly less blood loss (207 vs. 852.3 mL), were significantly less likely to receive a blood transfusion (4.3% vs. 30.3%), and had significantly shorter hospital stays (1.8 vs. 2.9 days).

The study demonstrated no significant between-group differences in 3- and 5-year recurrence-free survival (RFS) rates. Among men with at least 3 years of follow-up (493 in the RRP group and 99 in the RALP group), the 3-year RFS rates were 89.9% and 88.9% in the RRP and RALP groups, respectively. Among men with 5 or more years of follow-up (393 in the RRP group and 25 in the RALP group), the 5-year RFS rates were 84.7% and 88%, respectively.

The two groups also had similar proportions of patients with positive surgical margins and extracapsular extension and similar rates of various health-related quality of life outcomes, such as urinary incontinence, urinary obstruction, and sexual and bowel problems.

Data showed that the use of RALP increased during the study period, from 4.5% in 2003 to 85.2% in 2009.

“The strength of our population-based study is that all states within the United States were represented, allowing for a diverse cohort of patients treated by surgeons with varying experience and techniques,” the authors wrote.

The researchers cautioned, however, that their study needs to be interpreted with regard to its limitations. For example, the study was observational and limited to health professionals, who may have different access and knowledge regarding healthcare options and providers, thereby influencing RRP and RALP.

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