Comprehensive Prospective Comparative Analysis of Outcomes Between Open and Laparoscopic Radical Prostatectomy Conducted in 2003 to 2005
In a nonrandomized prospective fashion we compared the oncological, functional and morbidity outcomes after laparoscopic and retropubic radical prostatectomy.
Materials and Methods:
Between January 2003 and December 2005 a total of 1,430 consecutive men with clinically localized prostate cancer underwent radical prostatectomy, laparoscopic in 612 and retropubic in 818. The surgical approach was selected by the patient. Preoperative staging, respective surgical techniques, pathological examination and followup were uniform. Functional outcome was measured by patient completed health related quality of life questionnaire.
Positive surgical margin rates (11%) and freedom from progression (median followup 18 months) were comparable between laparoscopic and retropubic radical prostatectomy (HR 0.99 for laparoscopic vs retropubic radical prostatectomy, p = 0.9). We found no significant association between operation type and time to postoperative potency (HR 1.04 for laparoscopic vs retropubic radical prostatectomy; 95% CI 0.74, 1.46; p = 0.8). Patients who underwent laparoscopic radical prostatectomy were less likely to become continent than those treated with retropubic radical prostatectomy (HR 0.56 for laparoscopic vs retropubic radical prostatectomy; 95% CI 0.44, 0.70; p <0.0005). Laparoscopic radical prostatectomy was associated with less blood loss (mean ml ± SD 315 ± 186 vs 1,267 ± 660) and lower overall transfusion rate (3% vs 49%). No significant difference was noted in cardiovascular, thromboembolic and urinary complications. Emergency room visits and readmissions were higher after laparoscopic radical prostatectomy (15% vs 11% and 4.6% vs 1.2%, respectively).
At our institution and during the study period laparoscopic radical prostatectomy and retropubic radical prostatectomy provided comparable oncological efficacy. Laparoscopic radical prostatectomy was associated with less blood loss and a lower transfusion rate, and higher postoperative hospital visits and readmission rate. While the recovery of potency was equivalent, that of continence was superior after retropubic radical prostatectomy.
- 1 : A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst1998; 90: 766. Google Scholar
- 2 : Laparoscopic radical prostatectomy: the Montsouris technique. J Urol2000; 163: 1643. Link, Google Scholar
- 3 : Laparoscopic radical prostatectomy. Urol Oncol2004; 22: 133. Google Scholar
- 4 :
Radical prostatectomy for clinical stage T1 and T2 prostate cancer. In: Comprehensive Textbook of Genitourinary Oncology. Edited by . Baltimore: Williams & Wilkins1996: 722. Google Scholar
- 5 : Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: A multi-institutional update. JAMA1997; 277: 1445. Google Scholar
- 6 : Impotence following radical prostatectomy: insight into etiology and prevention. J Urol1982; 128: 492. Link, Google Scholar
- 7 : Laparoscopic radical prostatectomy: initial short-term experience. Urology1997; 50: 854. Google Scholar
- 8 : Laparoscopic radical prostatectomy: Preliminary evaluation after 28 interventions. Presse Med1998; 27: 1570. Google Scholar
- 9 : Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases at Montsouris Institute. J Urol2003; 169: 1261. Link, Google Scholar
- 10 : Laparoscopic radical prostatectomy with the Heilbronn technique: oncological results in the first 500 patients. J Urol2005; 173: 761. Link, Google Scholar
- 11 : Laparoscopic radical prostatectomy: The Creteil experience. Eur Urol2001; 40: 38. Google Scholar
- 12 : Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol2005; 174: 1271. Link, Google Scholar
- 13 : Vattikuti institute prostatectomy: contemporary technique and analysis of results. Eur Urol2007; 51: 648. Google Scholar
- 14 : Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev2006; . CD006231. Google Scholar
- 15 : Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol2003; 20: 360. Google Scholar
- 16 : Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol2003; 169: 1689. Link, Google Scholar
- 17 : Outcome and complications of radical prostatectomy in patients with PSA <10 ng/ml: comparison between the retropubic, perineal and laparoscopic approach. Prostate Cancer Prostatic Dis2002; 5: 285. Google Scholar
- 18 : Laparoscopic radical prostatectomy: a critical analysis of surgical quality. Eur Urol2006; 49: 625. Google Scholar