Limited high-quality studies compared robot-assisted laparoscopic prostatectomy (RALP) versus open retropubic radical prostatectomy (RRP). We sought to compare their postoperative outcomes in a randomized setting.
In a single center, 354 men with newly diagnosed prostate cancer were assessed for eligibility; 342 were randomized (1:1). The primary outcome was 90 days-complication rates. Functional outcomes and quality of life (QoL) were assessed over 18 months, while oncological outcomes, biochemical recurrence free survival and additional treatment, over 36 months.
From 2014-18, 327 patients underwent surgery (RRP = 156; RALP = 171). Complications occurred in 27 (17.3%) vs 19 (11.1%), P = .107. Patients undergoing RALP experienced lower median bleeding (250.0 vs 719.5 ml; P < .001) and shorter hospitalization time. Urinary EPIC median scores were better for RALP over 18 months, with higher continence rate at 3 months (80.5% vs 64.7%; P = .002), 6 months (90.1% vs 81.6%; P = .036) and 18 months (95.4% vs 78.8%; P < .001). Sexual EPIC and SHIM median scores were higher with RALP up to 12 months, while the potency rate was superior at 3 months 23.9% vs 5.3% (P = .001) and 6 months 30.6% vs 6.9% (P < .001). QoL over the 18 months and oncological outcomes over 36 months were not significantly different between arms.
Complications at 90 days were similar. RALP showed superior sexual outcomes at one year, improved urinary outcomes at 18 months, and comparable oncological outcomes at 36 months.
The Journal of urology. 2024 May 09 [Epub ahead of print]
William Carlos Nahas, Gilberto José Rodrigues, Fabio Augusto Rodrigues Gonçalves, Guilherme Vinícius Sawczyn, Guilherme Garcia Barros, Leonardo Cardili, Giuliano Betoni Guglielmetti, Arnaldo José De Carvalho Fazoli, Maurício Dener Cordeiro, Valter Dell Acqua Cassão, Daher Cesar Chade, Luiz Carlos Neves De Oliveira, Cláudio Bovolenta Murta, José Pontes Júnior, Evelinda Marramon Trindade, Diogo Assed Bastos, Alvaro Sadek Sarkis, Anuar Ibrahim Mitre, Quoc-Dien Trinh, Rafael Ferreira Coelho
Urologia, Instituto do Cancer do Estado de Sao Paulo Octavio Frias de Oliveira (ICESP), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Laboratorio de Medicina Laboratorial (LIM03), Hospital da Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Patologia, Instituto do Cancer do Estado de Sao Paulo Octavio Frias de Oliveira (ICESP), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Laboratorio de Ensino, Pesquisa e Inovacao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Oncologia Clinica, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil., Urology, Dana-Farber/Brigham and Women's Prostate Cancer Center, Harvard Medical School, Boston, Massachusetts.