Robotic Prostatectomy: A Review Of Outcomes Compared With Laparoscopic And Open Approaches

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 27 Jun 2008 - 2:00 PDT

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UroToday.com - In the online version of Urology, The group of Dr. Ashutosh Tewari at Cornell University review outcomes comparisons of open (RRP), laparoscopic (LRP), and robotic assisted (RALP). They reviewed only studies with a sample size of 40 or more patients.

Regarding intraoperative results, blood loss, operative time, complications and cancer control indicators were assessed. For 22 reports, mean operative time was164 minutes for RALP, compared to 227 for LRP and 147 for RRP. The mean EBL was 152ml for RALP, 406ml for LRP and 697ml for RRP. The transfusion rates were 2.9% for RALP, 8.3% for LRP and 24% for RRP. Conversion to open RP occurred in 0.5% of RALPs and 1.5% of LRPs. The mean time to foley catheter removal was 8.4 days for RALP, 6.9 days for LRP, and 8.4 days for RRP.

The mean overall surgical complication rate for RALP was 6.6%, compared to 15.6% for LRP and 10.3% for RRP. Death rates were low for all procedures. RALP had the lowest positive surgical margin rate at 12.5%, LRP 19.6% and RRP 23.5%. More pT3 tumors were in the RRP group, however. At 12 months, continence was 98% with RALP and LRP, compared with up to 92.1% for RRP. The variability in reporting this is likely influential. Twelve months following bilateral nerve-sparing, potency was up to 97% for RALP, 79% for LRP and 86% for RRP.

Presently RALP is the most common approach to radical prostatectomy in the US. This review is difficult to interpret, as the individual reports of types of surgical approaches are mostly not randomized nor from the same centers. A randomized trial in this area will not happen, so physicians and patients will have to evaluated surgeons and centers based upon their expertise, volumes and outcomes as well as patient preferences to decide on the type of radical prostatectomy to have.

Berryhill R, Jhaveri JJ, Yadav R, Leung R, Rao S, El-Hakim A, Tewari A
Urology. 2008 Apr 23 (Epub ahead of print)
doi:10.1016/j.urology.2007.12.038

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

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