Comparison of Treatment Outcomes between Laparoscopic and Robot-Assisted Laparoscopic Radical Prostatectomy in Clinically Localized Prostate Cancer, A Single-Surgeon Experience

Abstract

Objective: To compare the treatment outcomes between laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP) in clinically localized prostate cancer in a tertiary care hospital in Thailand by a single-surgeon experience. Materials and Methods: Between January 2013 and June 2019, 171 patients with clinically localized prostate cancer underwent minimally invasive radical prostatectomy. These were LRP in 62 patients and RALP in 109 patients. All clinical data were retrospectively reviewed. Patient demographic data, perioperative parameters, pathological reports, oncological outcomes, and functional outcomes including continence and potency rate at 1, 3, 6, and 12 months were compared between groups. Results: Patients in the RALP group were significantly younger (p=0.03) and had a shorter follow-up period (p=0.004). The estimated blood loss was significantly lower in the RALP group (p=0.001). There were no significant differences in intraoperative and 30-day postoperative complications. Pathological results and overall positive surgical margin rate (PSM) were not significantly different. In pT3 patients, PSM was significantly lower in the RALP group (p=0.045). Oncological outcomes were not different in term of biochemical recurrence (BCR) rate (p=0.3), median time to BCR (p=0.45), BCR-free survival (p=0.81), and overall survival (p=0.99). The continence rate was significantly better in the RALP group in every period after surgery (p=0.01, <0.001, 0.001, and p=0.02 at 1, 3, 6 and 12 months, respectively). The potency rate who performed bilateral neurovascular bundles sparing was not different between groups. Conclusion: RALP provided a significant improvement of continence recovery and PSM rate in non-organ confined disease. Estimated blood loss was significantly lower among the RALP patient. Larger numbers of patients with longer follow-up will justify proofing these findings. Keywords: Laparoscopic surgery, Robot-assisted surgery, Radical prostatectomy, Prostate cancer