Laparoscopic radical prostatectomy is also oncologically safe and effective!

Abstract

Fifteen years ago laparoscopic radical prostatectomy was successfully introduced as a minimally invasive treatment option for localized prostate cancer 1. This procedure was associated with a significant learning curve with regard to operating time and peri-operative complications 2, 3; however, now the curve has been passed, functional results have been at least equal to open radical prostatectomy with the advantage of reduced morbidity 4. As time has passed, we are now able to present mid- and long-term oncological results 5, 6. In their large retrospective study, Wirth et al. 6 present a significant contribution to the body of evidence that laparoscopic radical prostatectomy is oncologically safe and equally effective compared with open surgery. Unfortunately, urologists have not been able to conduct a randomized controlled trial to prove this as surgeons have done with laparoscopic colon resection 7. As a result, guideline recommendations will never reach grade A. Nevertheless, there is no oncological risk concerning laparoscopy. Reports such as this one by Wirth et al. are very important to support the further development of laparoscopic and robot-assisted radical prostatectomy. The next step will be to look into overall and cancer-specific survival data. The first reported data indicate distinct advantages over retropubic radical prostatectomy 5. In my view, the train has left the station and we will never return to open surgery when dealing with localized prostate cancer. The learning curve has been passed, with the help of the use of the robot, and the advantages of video-assisted surgery are evident. None declared.