Presentation Authors: Alexander Haese, Hendrik Isbarn, Sophie Knipper*, Hans Heinzer, Derya Tilki, Georg Salomon, Uwe Michl, Thomas Steuber, Lars Budäus, Tobias Maurer, Pierre Tennstedt, Hartwig Huland, Markus Graefen, Hamburg, Germany
Introduction: Reliable data on comparisons of open retropubic radical prostatectomy (ORP) vs. robot-assisted laparoscopic radical prostatectomy (RARP) is scarce and remains inconclusive.
Methods: We identified 10,790 consecutive treated patients (7007 ORP vs. 3783 RARP) within our prospective database (2008-2016). All procedures were performed by seven highly trained surgeons performing both surgical approaches regularly. Oncological (48-month biochemical recurrence rate [BCR]), functional (urinary continence, erectile function) and surgical (rate of nerve-sparing procedures, lymph node yield, surgical margin status, length of hospital stay, operation time, blood loss, transfusion rate, time to catheter removal) outcomes were assessed. Kaplan-Meier, multivariable Cox and logistic regression models were used to test for BCR and functional outcome differences.
Results: No statistically significant difference regarding oncological outcome distinguished between ORP vs. RARP. Regarding functional outcomes, one-week continence rates were higher in ORP (25.8% vs. 21.8%, p < 0.001). At three months, no statistically significant differences were observed. At one year, continence rates were modestly higher in RARP (90.3% vs. 88.8%, p=0.01). This effect was no longer observed after stratification for age-groups. One-year potency rates were similar in ORP vs. RARP (80.3% vs. 83.6%, p=0.33). Regarding surgical outcomes, no significant difference was observed in rates of nerve-sparing procedures, lymph node yield, surgical margin status, and length of hospital stay. Conversely, operation time was shorter in ORP, and blood loss, transfusion rates and length of catheter stay were significantly lower in RARP.
Conclusions: Both surgical approaches, performed in a high-volume center by the same surgeons, achieve excellent, comparable oncological and functional outcomes. However, a slight advantage for RARP regarding surgical outcomes was observed.