Korean J Urol.  2008 Oct;49(10):886-892. 10.4111/kju.2008.49.10.886.

Comparison of Open versus Robotic Radical Prostatectomy in Clinically Advanced Prostate Cancer

• Ham WS
• Park SY
• Rha KH
• Choi YD

• KMID: 1204317
• DOI: http://doi.org/10.4111/kju.2008.49.10.886

Abstract

PURPOSE: To evaluate the outcomes of robotic prostatectomy(RP) compared with open radical prostatectomy(OP) in clinically advanced prostate cancer(PC).
MATERIALS AND METHODS
Between January 2003 and June 2007 we performed radical prostatectomy in 180 patients with clinically advanced PC (OP, 88; RP, 92). We compared the perioperative parameters and early surgical outcomes between the OP and RP groups in patients with and without neoadjuvant hormonal therapy(NHT).
RESULTS
In patients without NHT, there were no significant differences in preoperative characteristics between the OP and RP groups, but in patients with NHT, the RP patients had higher biopsy Gleason scores(GS) and clinical stages. There were no significant differences in lymph node (LN) invasion and extracapsular extension(ECE), but a significant difference existed in the prostatectomy GS between the OP and RP groups, regardless of NHT. The positive surgical margin rates in the RP group were similar to or lower than in the OP groups when stratified by pathologic stages T2 and T3. Irrespective of NHT, in the RP group the mean estimated blood loss was decreased, the mean duration of the hospital stay was less, and the length of bladder catheterization was shorter, but there were no significant differences in the postoperative day the regular diet was started or the frequency of complications. Although there were no significant differences in continence rates between the two groups, all the RP patients had a higher continence rate from 1 month postoperatively, with or without NHT.
CONCLUSIONS
Our results suggest that RP may be performed safely and may have results comparable to OP in clinically advanced PC.

Keyword

Prostatic neoplasms; Open radical prostatectomy; Robotic radical prostatectomy

MeSH Terms

Biopsy

Reference

1. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol. 1982. 128:492–497.

2. Meltzer D, Egleston B, Abdalla I. Patterns of prostate cancer treatment by clinical stage and age. Am J Public Health. 2001. 91:126–128.

3. Freedland SJ, Partin AW, Humphreys EB, Mangold LA, Walsh PC. Radical prostatectomy for clinical stage T3a disease. Cancer. 2007. 109:1273–1278.

4. Carver BS, Bianco FJ, Scardino PT, Eastham JA. Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. J Urol. 2006. 176:564–568.

5. Montie JE. Initial therapy with radical prostatectomy for high risk localized prostate cancer. J Urol. 2006. 176:9.

6. Ward JF, Slezak JM, Blute ML, Bergstralh EJ, Zincke H. Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int. 2005. 95:751–756.

7. Thompson IM, Carroll PR, Carducci MA. Recommendations for defining and treating high risk localized prostate cancer. J Urol. 2006. 176:S6–S10.

8. Guillonneau B, el-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute. J Urol. 2003. 169:1261–1266.

9. Bhayani SB, Pavlovich CP, Hsu TS, Sullivan W, Su LM. Prospective comparison of short-term convalescence: laparoscopic radical prostatectomy versus open radical retropubic prostatectomy. Urology. 2003. 61:612–616.

10. Boccon-Gibod L. Radical prostatectomy: open? Laparoscopic? Robotic? Eur Urol. 2006. 49:598–599.

11. Hara I, Kawabata G, Miyake H, Nakamura I, Hara S, Okada H, et al. Comparison of quality of life following laparoscopic and open prostatectomy for prostate cancer. J Urol. 2003. 169:2045–2048.

12. Jaffe J, Stakhovsky O, Cathelineau X, Barret E, Vallancien G, Rozet F. Surgical outcomes for men undergoing laparoscopic radical prostatectomy after transurethral resection of the prostate. J Urol. 2007. 178:483–487.

13. Touijer K, Guillonneau B. Laparoscopic radical prostatectomy: a critical analysis of surgical quality. Eur Urol. 2006. 49:625–632.

14. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Zagaja GP, Shalhav AL. Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol. 2007. 51:755–762.

15. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002. 60:864–868.

16. Nelson B, Kaufman M, Broughton G, Cookson MS, Chang SS, Herrell SD, et al. Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol. 2007. 177:929–931.

17. Webster TM, Herrell SD, Chang SS, Cookson MS, Baumgartner RG, Anderson LW, et al. Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. J Urol. 2005. 174:912–914.

18. Tewari A, Srivasatava A, Menon M. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 2003. 92:205–210.

19. Song KH, Park H, Han JY, You CH, Ahn H, Kim CS. The effect of neoadjuvant hormonal treatment in prostate cancer on biochemical recurrence. Korean J Urol. 2007. 48:1125–1130.

20. Deliveliotis C, Protogerou V, Alargof E, Varkarakis J. Radical prostatectomy: bladder neck preservation and puboprostatic ligament sparing-effects on continence and positive margins. Urology. 2002. 60:855–858.

21. Ludwikowski B, Oesch Hayward I, Brenner E, Fritsch H. The development of the external urethral sphincter in humans. BJU Int. 2001. 87:565–568.

22. Myers RP. Detrusor apron, associated vascular plexus, and avascular plane: relevance to radical retropubic prostatectomy-anatomic and surgical commentary. Urology. 2002. 59:472–479.

23. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology. 2004. 63:819–822.