Radical Prostatectomy For Prostatic Adenocarcinoma: Matched Comparison Of Retropubic And Robot Assisted Techniques

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 22 Jun 2008 - 0:00 PDT

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ORLANDO, FL (UroToday.com) - A group of investigators from the Mayo Clinic assessed peri-operative complications and early oncologic results in a comparative study matching radical retropubic (RRP) and robot assisted laparoscopic prostatectomy (RALP) groups.

From August 2002 and December 2005, they identified 294 patients undergoing RALP for clinically localized prostate cancer. A comparison RRP group (n=588) from the same period was matched 2:1 for surgical year, age, preoperative PSA, clinical stage and biopsy Gleason grade. Peri-operative complications were compared. Pathologic features were assessed and Kaplan-Meier estimates of biochemical progression free survival (PFS) were compared.

Peri-operative complications were higher in the RALP group (16.4% vs. 9.8%, p = 0.007), of which extravasation on cystogram was more common in the RALP group, (9.1% vs. 2.5%, p<0.001). Hospital days were less for the RALP cohort (29.3%, vs. 19.4%, p=0.004, for 1 hospital day). Differences in age, preoperative PSA, pathologic stage, pathologic Gleason grade and margin positivity were not significant between the 2 groups. At one year follow-up there was no significant difference in continence (RALP 91.8%, RRP 93.7%, p=0.344) or potency (RALP 70.0%, RRP 62.8%, p=0.081) rates between the two groups. Three-year biochemical PFS was not different among treatment options (RALP 92.4%, RRP 92.2%; p=0.69).

They conclude that RALP was associated with significantly higher early complication rates compared to RRP; however, there was no difference in long-term continence or potency rates between the two techniques. Furthermore, early oncologic outcomes were similar with no difference in margin positivity or short-term PFS between the two groups.

Presented by Amy E Krambeck, MD, David S DiMarco, MD, Laureano J Rangel, MD, Eric J Bergstralh, MD, Michael L Blute, MD, Matthew T Gettman, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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