Open and laparoscopic RP offer similar success rates

Open radical prostatectomy and laparoscopic radical prostatectomy, with or without robotic assistance, appear to offer comparable rates of success, according to a recent study from Memorial Sloan-Kettering Cancer Center, New York.

Study authors advise that men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision making and set realistic expectations.

The study, which was published online in the Journal of Urology (Feb. 24, 2010), compared open and laparoscopic RP outcomes in a population-based cohort of almost 6,000 men 66 years of age or older with clinically localized prostate cancer and examined the impact of surgeon volume in men treated with laparoscopic RP.

"A concern of these authors is the perception among patients that the robotic approach to prostatectomy is significantly superior," said Yair Lotan, MD of the University of Texas Southwestern Medical Center, Dallas, who was not part of the study. "Patients deserve to have a realistic expectation of surgical outcomes, especially considering the multiple other available treatment options.

"Notably, the main information that a patient must know is not the prostatectomy approach but surgeon experience. Several studies show that the primary determinant of prostatectomy outcome is surgical volume."

After adjusting for patient and tumor characteristics, there were no differences in the rate of general medical/surgical complications or genitourinary/bowel complications, or in postoperative radiation and/or androgen deprivation. Laparoscopic RP was associated with a 35% shorter hospital stay and a lower bladder neck/urethral obstruction rate. In laparoscopic cases, the surgeon’s experience with the procedure was inversely associated with hospital stay and the odds of any genitourinary/bowel complication.

"Results suggest that open RP and laparoscopic RP have similar rates of postoperative mortality and morbidity," said first author William T. Lowrance, MD of Memorial Sloan-Kettering Cancer Center. "Controlling for important patient and tumor characteristics, the only differences favoring laparoscopic RP were shorter length of stay and a lower risk of bladder neck or urethral obstruction. All men considering radical prostatectomy should be clearly informed about the differences between the two techniques and similarities in their expected outcomes and make treatment decisions in collaboration with an experienced surgeon."