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

    The first published randomized controlled trial comparing robot-assisted laparoscopic prostatectomy (RALP) with open radical retropubic prostatectomy (ORPP) found no statistically significant differences between the two procedures in primary outcomes analyses of standard oncologic and functional parameters at 12 weeks.

    Urology Times reached out to several key opinion leaders for their interpretation of the results. Their analyses centered on postoperative complications between the surgical approaches, the need to account for findings from other studies, oncologic outcomes, and cost differences.

    Follow-up is now continuing in this single-center Australian study in which the procedures were performed by two surgeons, and functional outcomes and disease progression will be assessed at 24 months.

    The study was powered to assess health-related and domain-specific quality of life outcomes over 24 months, and it enrolled men ages 35 to 70 years choosing surgery for treatment of newly diagnosed clinically localized prostate cancer; 157 men underwent RALP and 151 men had ORPP.

    As reported in the paper, which was published online in The Lancet (July 26, 2016), there were no statistically significant differences between surgical groups at 6 weeks or 12 weeks in mean scores for urinary function (urinary domain of EPIC) or sexual function (EPIC sexual domain and IIEF total score) nor in rates of positive surgical margin status (RALP, 15% vs. ORPP, 10%).

    A review of perioperative outcomes showed statistically significant differences favoring RALP over ORPP for the intraoperative adverse event rate (2% vs. 8%), estimated blood loss (443.74 mL vs. 1338.14 mL), and hospital stay (1.55 vs. 3.27). RALP had a lower postoperative complication rate than the open procedure (4% vs. 9%), but the difference was not statistically significant. There were also no statistically significant differences between groups in rates of blood transfusion, intensive care unit admission, hospital readmission, or indwelling catheter days. Mean scores for pain during activities and worst pain were significantly lower in the RALP group at day 1 and week 1, but not at later follow-up.

    Next: Drs. Koch, Menon, Nelson discuss study


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