Robotic Assisted Laparoscopic Prostatectomy Versus Radical Retropubic Prostatectomy for Clinically Localized Prostate Cancer: Comparison of Short-Term Biochemical Recurrence-Free Survival.
Barocas DA, Salem S, Kordan Y, Herrell SD, Chang SS, Clark PE, Davis R, Baumgartner R, Phillips S, Cookson MS, Smith JA Jr.
The Department of Urologic Surgery and Department of Biostatistics (SP) at the Vanderbilt University Medical Center in Nashville, Tennessee monitored 491 radical retropubic prostatectomy patients and 1,413 robotic-assisted laparoscopic prostatectomy patients to compare short-term cancer recurrence risk factor outcomes. Results revealed that robotic prostatectomy patients presented a slightly lower recurrence risk at the 10-month mark with a lower prostate specific antigen (PSA) (5.4% vs 5.8%), pathological grade of 7-10 (48.4% vs 54.7%), as well as a lower pathological stage (80.5% pT2 vs 69.6% pT2) when compared to radical retropubic prostatectomy patients. At the three-year mark, risk indicator results between the two procedures were similar. In conclusion, the likelihood of biochemical recurrence is comparable when assessing the known indicators of prostate cancer recurrence. As such, robotic-assisted laparoscopic prostatectomy procedures are as effective as traditional retropubic surgeries in terms of short-term prostate cancer recurrence risk.
Radical Prostatectomy for Prostatic Adenocarcinoma: A Matched Comparison of Open Retropubic and Robot-assisted Techniques.
Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML, Gettman MT.
The Department of Urology, Mayo Medical School, and Mayo Clinic in Rochester, Minnesota examined the perioperative complications and early onocological results in patients having a radical retropubic prostatectomy (RRP) versus a robotic-assisted radical prostatectomy (RALP). This study occurred over a period of three years and monitored 295 robotic prostatectomy patients and 588 retropubic prostatectomy cases. These patients were comparative in terms of surgery year, age, preoperative prostate specific antigen (PSA) levels, clinical stage, and Gleason grade. When comparing perioperative complications, there was no significant difference. Wound herniation was more common after robotic-assisted radical prostate surgeries (1.0% RALP vs. zero RRP) with bladder neck contracture more commonly reported after radical retropubic procedures (1.2% RALP vs. 4.6% RRP). The hospital stay was less after robotic prostate cancer removal (29.3% RALP vs. 19.4% RRP for a stay of one-day) and results were comparable at the one-year follow-up for incontinence rates (91.8% RALP, 93.7 % RRP) and potency (70.0% RALP, 62.8% RRP) rates. In conclusion, clinical evidence suggests there is no significant difference between procedures when comparing surgical complications, long-term continence and potency, as well as oncological outcomes.
A Prospective, Non-randomized Trial Comparing Robot-assisted Laparoscopic and Retropubic Radical Prostatectomy in one European Institution.
Ficarra V, Novara G, Fracalanza S, D'Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W.
After monitoring 105 radical retropubic prostatectomy (RRP) patients and 103 robotic-assisted radical prostatectomy (RALP) patients, doctors at one European institution compared the outcomes of these two procedures. Their findings revealed an average operating time of 135 minutes and 185 minutes for retropubic open procedures and robotic-assisted prostatectomies respectively. Total intraoperative blood loss measured 500ml for open procedures and 300ml for robotic prostate removal, averaging a postoperative transfusion rate of 14% for RRP and 1.9% for RALP. Complications arose in 9.7% of RRP patients and 10.4% of RALP cases with a positive surgical margin measuring 12.2% and 11.7% for patients with pT2 cancers. In terms of urinary continence, 41% of patients having RRP and 68.9% of those having RALP were continent immediately after catheter removal and at the 12-month mark, 88% were continent after RRP, and 87% after RALP. At this same year milestone, potency levels were as follows: 49% of RRP patients experienced a return of erectile function vs. 81% of RALP patients receiving bilateral nerve-sparing procedures. In conclusion, clinical evidence suggests RALP patients experience more positive results in terms of continence and erectile function and similar results in regards to biochemical margins.
Prostate Cancer Surgery – Clinical Outcomes of Robot-Assisted Radical Prostatectomy (RARP)
Ahlering, Thomas, MD, 2 May 2010
At the University of California’s Department of Urology at Irvine, Dr. Thomas Ahlering has been performing and reporting on Robotic Prostatectomies since 2002. According to his findings, “robotic prostatectomy produces superior outcomes for the patient in reduced blood loss, nearly zero blood transfusion, low complication rates, earlier return to work, and excellent oncological outcomes with low positive margin rates. The rate of return for pad-free urinary control in men is ~80% at 3 months and ~95% at one year after surgery. These findings validate the wisdom of the transition from open surgery to robotic prostatectomyi.”
It was also noted that patients who undergo robotic prostatectomy have ten-year disease specific survival rates greater than 90%. Not only are more men surviving, but they do not have to sacrifice potency. Dr. Ahlering’s study focused on preserving erectile function while still diminishing cancer. Using this new robotic technique preserved more nerves needed to have an erection. In fact, about 32% of pre-potent men with “unilateral or bilateral nerve preservation” are able to produce erections firm enough for intercourse within three months post-procedure, ~60% after nine months, and about 90% after 24 monthsii.