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JU INSIGHT Outcomes Between Robot-Assisted Laparoscopic Prostatectomy and Open Radical Retropubic Prostatectomy
By: William Carlos Nahas, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Gilberto José Rodrigues, MD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Fabio Augusto Rodrigues Gonçalves, PharmD, Hospital da Clinicas, Universidade de Sao Paulo, Brazil; Guilherme Vinícius Sawczyn, MD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Guilherme Garcia Barros, MD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Leonardo Cardili, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Giuliano Betoni Guglielmetti, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Arnaldo José De Carvalho Fazoli, MD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Maurício Dener Cordeiro, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Valter Dell Acqua Cassão, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Daher Cesar Chade, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Luiz Carlos Neves De Oliveira, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Cláudio Bovolenta Murta, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; José Pontes Júnior, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Evelinda Marramon Trindade, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Diogo Assed Bastos, PhD, Oncologia Clinica, Hospital Sirio-Libanes, Sao Paulo, Brazil; Alvaro Sadek Sarkis, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Anuar Ibrahim Mitre, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil; Quoc-Dien Trinh, PhD, Dana-Farber/Brigham and Women’s Prostate Cancer Center, Harvard Medical School, Boston, Massachusetts; Rafael Ferreira Coelho, PhD, Instituto do Cancer do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clinicas, Universidade de Sao Paulo, Brazil | Posted on: 17 Jul 2024
Nahas WC, Rodrigues GJ, Rodrigues Gonçalves FA, et al. Out comes between robot-assist ed laparoscopic prostatectomy and open radical retropubic prostatectomy: a randomized clinical trial. J Urol. 2024;212(1):32-40. doi:10.1097/JU.0000000000003967
Study Need and Importance
Limited high-quality studies have compared robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy. We sought to compare their postoperative outcomes in a randomized setting at a high-volume oncological center from Latin America. The study included more than 300 patients who were submitted to radical prostatectomy by multiple proficient surgeons in each arm.
What We Found
No significant differences were found in complications up to 90 days post surgery between the groups, quality of life over 18 months, or biochemical recurrence–free survival and additional treatment over 36 months. Patients undergoing RALP experienced statistically significant longer operative time, lower median bleeding, and shorter hospitalization time (Table). Urinary EPIC (Expanded Prostate Cancer Index Composite) median scores were better for RALP over the 18 months analyzed, 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 Sexual Health Inventory for Men 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).
Table Main Findings From a Randomized Controlled Trial Between Retropubic Radical Prostatectomy and Robot-Assisted Laparoscopic Prostatectomy
| RRP (N = 156) |
RALP (N = 171) |
P value | |
|---|---|---|---|
| Perioperative outcomes | |||
| Operative time, median, (IQR), min | 120.0 (89.5, 155.0) | 212.0 (145.0, 257.8) | < .001 |
| Estimated blood loss, median, (IQR), mL | 719.5 (418.8, 1076.5) | 250.0 (150.0, 430.0) | < .001 |
| Length of stay (d), No. (%) | < .001 | ||
| 1 | 79 (50.6) | 118 (69.0) | |
| 2 | 47 (30.1) | 38 (22.2) | |
| 3+ | 30 (19.2) | 15 (8.8) | |
| Functional outcomes, median (IQR) | |||
| 3 mo | |||
| EPIC urinary domain | 76 (62, 89) | 85 (73, 95) | < .001 |
| EPIC sexual domain | 19 (6, 31) | 24 (10, 41) | .009 |
| SHIM | 6.00 (5.00, 9.00) | 7.00 (5.00, 13.00) | .007 |
| 6 mo | |||
| EPIC urinary domain | 86 (73, 96) | 92 (81, 98) | .002 |
| EPIC sexual domain | 24 (12, 34) | 31 (17, 46) | .009 |
| SHIM | 6.00 (5.00, 10.00) | 9.00 (5.00, 14.00) | .002 |
| 12 mo | |||
| EPIC urinary domain | 90 (78, 97) | 93 (85, 100) | .016 |
| EPIC sexual domain | 26 (15, 43) | 34 (15, 52) | .048 |
| SHIM | 7.00 (5.00, 14.00) | 12.00 (5.00, 17.00) | .008 |
| 18 mo | |||
| EPIC urinary domain | 89 (76, 97) | 94 (84, 100) | .003 |
| EPIC sexual domain | 33 (17, 52) | 39 (23, 55) | .110 |
| SHIM | 10.00 (5.00, 17.00) | 12.50 (5.75, 17.00) | .376 |
| Abbreviations: EPIC, Expanded Prostate Cancer Index Composite; RALP, robot-assisted laparoscopic prostatectomy; RRP, retropubic radical prostatectomy; SHIM, Sexual Health Inventory for Men. | |||
Limitations
This was a single center with limited funding, which resulted in an incomplete randomization process by a few patients and the lack of postoperative sexual and urinary rehabilitation.
Interpretation for Patient Care
Complications at 90 days were similar. RALP showed superior sexual outcomes over 1 year, improved urinary outcomes over 18 months, and comparable oncological outcomes at 36 months.
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