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Long-term comparative outcome analysis of a robot-assisted laparoscopic prostatectomy with retropubic radical prostatectomy by a single surgeon

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Abstract

We aimed to report a comprehensive outcome analysis of robot-assisted laparoscopic prostatectomies (RALP) performed by a single surgeon and compared it to retropubic radical prostatectomies (RRP) done by the same surgeon in a high-volume center. Preoperative, perioperative, and postoperative data were collected prospectively and compared with retrospective retropubic radical prostatectomy data. Perioperative, oncological data, and functional results in the first year were compared between the two groups. There were 547 RARPs between 4th August 2011 and 31st December 2018, and 428 RRPs between 1st January 1996 and 31st December 2009 which were included in this review. While the operation time was in favour of the open group (196 vs 160 min, p < 0.01), the estimated blood loss (188 vs 316 ml, p < 0.01), blood transfusion rate (3% vs 7%, p = 0.021), hospital stay (4 days vs 7 days), and mean catheter duration (12 vs 15 days) were in favour of the robotic group. Majority of the complications belonged to Clavien–Dindo group II in both groups and the rates were not significantly different (p = 0.33). The 12-month continence rate was in favour of the RALP group (98.3% vs 99.2%, p < 0.01). Overall survival of the RALP cohort at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%), and 108 months was 79.5%. Overall survival at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%, and 108 months 79.5%. RALP is a safe, minimally invasive, technically feasible procedure with comparable functional and oncological outcomes. Our study showed superior perioperative and continence outcomes in RALP. However, despite its growing popularity, RRP still remains the gold standard in India due to its affordability and accessibility.

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Abbreviations

PSA:

Prostate-specific antigen

LRP:

Laparoscopic radical prostatectomy

RRP:

Retropubic radical prostatectomy

RALP:

Robot-assisted laparoscopic prostatectomy

SWOT:

Strengths, weaknesses, opportunities, and threats

MRI:

Magnetic resonance imaging

BMI:

Body mass index

ADASP:

Association of Directors of Anatomic and Surgical Pathology

OS:

Overall survival

RFS:

Recurrence-free survival

CSS:

Cancer-specific survival

EFS:

Event-free survival

KM:

Kaplan–Meier

LOS:

Length of stay

PSM:

Positive surgical margin

BCR:

Biochemical recurrence

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This study received no external sources of funding.

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Authors and Affiliations

  1. Asian Cancer Institute-Cumballa Hill Hospital, 93, ACI Hospital, 95, August Kranti Rd, Kemps Corner, Cumballa Hill, Mumbai, Maharashtra, 400036, India

    Neeraja D. Tillu & Jagdeesh N. Kulkarni

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  1. Neeraja D. Tillu
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  2. Jagdeesh N. Kulkarni
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Contributions

Both authors contributed to the study's conception and design. Material preparation, data collection and analysis were performed by Jagdeesh Kulkarni. The first draft of the manuscript was written by Neeraja Tillu and both authors commented on previous versions of the manuscript. Both authors read and approved the final manuscript.

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Correspondence to Neeraja D. Tillu.

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Tillu, N.D., Kulkarni, J.N. Long-term comparative outcome analysis of a robot-assisted laparoscopic prostatectomy with retropubic radical prostatectomy by a single surgeon. J Robotic Surg 17, 677–685 (2023). https://doi.org/10.1007/s11701-022-01479-6

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