Comparative Analysis Of Surgical Margins Between Radical Retropubic Prostatectomy And RALP

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology;  Medical Devices / Diagnostics
Article Date: 11 Apr 2009 - 0:00 PDT

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UroToday.com - The purpose of this article was to compare surgical margin status between Radical Retropubic Prostatectomy [RRP] and Robotic Assisted Laparoscopic Prostatectomy [RALP] as performed by a single urologist. This topic has been addressed in multiple articles with comparable positive margin status between the two techniques. ^{1, 2}

What we felt was missing from previous published material was the exclusion of results from the learning curve or initial cases. This is important for urologists considering transferring from open to robotic surgery. There is substantial fear that the initial patients subjected to robotic surgery will be "experimented on" or "sacrificed". Does an experienced urologist with ample success at RRP have to compromise his patient's results in order to proceed forward with a new technology?

We retrospectively compared our last 50 of 1200 similarly matched RRP patients to our first 50 RALP patients, essentially comparing our best RRP (end of series) to our worst RALP (beginning of series). None of our initial robotic cases were omitted. To further ensure that we had similar cohorts we also matched the two groups according to pre-operative CAPRA scores.

The RALP group had fewer overall positive margins than the RRP group (22% vs. 36%, p=0.007) despite having fewer low risk patients and a higher proportion of patients with Gleason 7 disease.

The primary limitation of this study was related to its retrospective design and small patient population. We recognize that other peri-operative outcome measures are important (estimated blood loss, hospital stay, complications, short term functional outcomes, etc.) and are currently evaluating our existing data.

In addition we realize that our positive margin rate in the RRP group was high compared to most published series, but it does fall within our average range of previously examined data for our open cases.

We have demonstrated that a statistically significant lower positive margin rate can be achieved in RALP patients even during the learning curve.

References:

1. Smith JA, Chan RC, Chang SS, et al. A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol. 2007;178:2385-2390.
2. Laurila TAJ, Huang H, Jarrard DF. Robotic assisted laparoscopic and radical retropubic prostatectomy generates similar positive margin rates in low and intermediate risk patients. Urol Oncol. 2008 July 18. [Epub ahead of print]

Written by Michael A. White, Alexander P DeHaan, D. Dawon Stephens, Thomas K. Maatman, and Thomas J. Maatman as part of Beyond the Abstract on UroToday.com

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