Robotics and Laparoscopy
Midterm oncological outcomes of laparoscopic vs open radical prostatectomy (RP)
Correspondence: Douglas M. Dahl, Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
- To compare the midterm risks of biochemical recurrence (BCR) and salvage radiation therapy (SRT) after laparoscopic (LRP) and open retropubic radical prostatectomy (RRP). Strong evidence that these techniques are comparable to the ‘gold standard’ of open RRP is lacking, as most comparative studies are limited by short follow-up or rely on historical controls.
Patients and Methods
- We studied 1000 consecutive patients concurrently treated by either LRP or RRP between 2001 and 2005.
- LRPs were performed by a single surgeon and RRP by four surgeons.
- Primary outcomes were BCR and SRT. Survival analysis included relevant clinical and pathological variables.
- Of 844 included patients, 244 underwent LRP and 600 RRP.
- Clinical and pathological characteristics were similar in both groups. Most patients had Gleason 6 tumours (68%) and pT2 disease (86%). The median follow-up was 6.1 years and median time to recurrence 3.4 years.
- Overall, BCR occurred in 14% of patients: 13.1% after LRP and 14.7% after RRP.
- SRT was performed in 10.7% of patients both after LRP and RRP. In uni- and multivariate Cox regression models, surgical technique was not a significant predictor of BCR or SRT.
- Our results suggest that in high-volume centres, LRP provides equivalent oncological control to RRP.