Equivalent outcomes for robot-assisted and open radical prostatectomy
medwireNews: Robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy have similar functional outcomes at 2 years, according to phase III study findings in The Lancet Oncology.
“Robot-assisted laparoscopic prostatectomy has been widely adopted as the preferred surgical technique for radical prostatectomy without previous validation of improved outcomes,” highlight Suzanne Chambers (Griffith University, Gold Coast, Queensland, Australia) and colleagues.
“Our study showed that this technique can obtain equivalent functional outcomes to open surgery.”
At 24 months, 150 men managed with robot-assisted laparoscopic prostatectomy and 146 men managed with open radical retropubic prostatectomy had similar urinary function and sexual function scores, as assessed using Expanded Prostate Cancer Index Composite questionnaires. Urinary function scores were 91.33 in the laparoscopic group and 90.86 in the open prostatectomy group, while sexual function scores were 45.70 and 46.90, respectively.
Although there were fewer biochemical recurrences (defined as a prostate-specific antigen level of ≥0.2 ng/mL) in the laparoscopic group, at four versus 13 cases (3 vs 9%) in the open surgery group, Chambers and team advise caution when interpreting this finding because of differences in positive margins and follow-up management between the two groups.
In a related comment, Vidit Sharma and R Jeffrey Karnes (both from the Mayo Clinic, Rochester, Minnesota, USA) describe the difference in biochemical recurrence as “[p]erhaps the most controversial finding from this report” and agree with the authors that “the oncological data remains preliminary and should not be accorded too much weight.”
Nonetheless, Chambers and colleagues say: “The oncological outcomes for robot-assisted laparoscopic prostatectomy are promising and require ongoing follow-up and further investigation.”
The study participants had newly diagnosed, clinically localized prostate cancer and were randomly assigned to receive one of the two procedures. Only two surgeons were involved in the study with the aim of reducing surgical heterogeneity. However, as noted by Sharma and Karnes, it means “this trial remains a comparison of one robotic surgeon’s outcomes to another open surgeon’s outcomes,” which they say raises concerns about the generalizability of the results.
“Looking more holistically at the trial, differences in outcomes from the different operative approaches were probably less important than differences in outcomes from different surgeons,” said Sharma and Karnes.
They conclude: “The gold standard for prostate cancer surgery remains a high quality radical prostatectomy, regardless of the approach.”
By Catherine Booth
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