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    Robotic vs. open RP: Experts react to first randomized trial

     

    Speaking with Urology Times about the study, Michael Koch, MD, noted that just as when comparing other types of surgeries, the major difference between open and minimally invasive procedures was in the postoperative complication rate.

    “While the rate was almost twofold higher in the open prostatectomy group, the difference failed to achieve statistical significance, probably due to the relatively small sample size,” said Dr. Koch, of Indiana University School of Medicine, Indiana.

    Also see: Midlife PSA levels strongly portend future deadly PCa

    Mani Menon, MD, said that the findings of this well-designed study are consistent with previous research showing that RALP fulfills three important goals of minimally invasive surgery; ie, it reduces blood loss, postoperative pain, and complications compared with open surgery. The absence of any differences in early functional outcomes in this study, however, is at odds with longer term results from meta-analyses and comparative effectiveness studies, he said.

    “Before making definitive conclusions, it may be prudent to consider all of the available evidence in the field, rather than results from a single surgical group or using a particular analytic approach,” said Dr. Menon, of Vattikuti Urology Institute, Henry Ford Health System, Detroit.

    Joel Nelson, MD, said that the paper supports what most experienced prostatectomy surgeons already know, and that is that ORPP and RALP result in the same functional outcomes and also the same oncologic outcomes assuming both approaches remove the entire gland.

    He noted that use of cell salvage eliminates any disadvantage of ORPP for causing more blood loss. Importantly, a comparison of financial impact is missing in the study’s analyses, observed Dr. Nelson, of the University of Pittsburgh School of Medicine.

    Read - Hypofractionated vs. conventional RT: How outcomes, safety compare

    “In a setting of outcome equivalence between the two approaches, the value of the more expensive robotic approach is appropriately questionable,” he said.

    Next: Drs. Andriole, Lepor on the findings

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