Robot Assisted Prostate Cancer Surgery Shows Good Results

A new study shows that robot-assisted surgery for the removal of cancerous prostate has outcomes as good, if not better, than open or laparoscopic radical prostatectomy (RP) techniques.

Researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center (NYP; New York, NY, USA) and Karolinska University Hospital (Stockholm, Sweden) conducted a literature review and meta-analysis to compare margin and perioperative complication rates for open retropubic RP (ORP), laparoscopic RP (LRP), and robot-assisted LRP (RALP). The data were abstracted from 400 original research articles published between 2002 and 2010, representing 167,184 ORP, 57,303 LRP, and 62,389 RALP patients (total 286,876). The primary outcomes were positive surgical margin (PSM) rates, as well as total intra- and peri-operative complication rates.

The results showed that the LRP group had higher positive surgical margin rates than the RALP group, but similar rates to the ORP group. LRP and RALP showed significantly lower blood loss and transfusions, and a shorter length of hospital stay than the ORP group. Total perioperative complication rates were higher for ORP and LRP than for RALP. Total intraoperative complication rates were low for all modalities, but lowest for RALP. Rates for readmission, reoperation, nerve, ureteral, and rectal injury, deep vein thrombosis (DVT), pneumonia, hematoma, lymphocele, anastomotic leak, fistula, and wound infection showed significant differences between groups, generally favoring RALP. The study was published early online on February 24, 2012, in European Urology.

“We would love to be able to directly compare the three prostatectomy surgical techniques, but that may not happen. This study is the first to provide an important, and much needed, analysis of the short term benefits and risks between curative surgeries that many men rely on,” said lead author, Ashutosh Tewari, MD, director of the Prostate Cancer Institute at NYP. “Since the robotic technology is expensive, the patient benefits often get intertwined with the societal costs. It is clear, however, that robotic surgery is the most popular surgical modality today.”

Related Links:
New York-Presbyterian Hospital/Weill Cornell Medical Center
Karolinska University Hospital