Leading center finds outcomes of lap, open RP comparable

May 20, 2007

When performed by the hands of experienced prostate cancer surgeons at a center of excellence, laparoscopic radical prostatectomy (LRP) and open retropubic radical prostatectomy (RRP) are associated with comparable outcomes in the treatment of clinically localized prostate cancer, according to findings reported by urologists from Memorial Sloan-Kettering Cancer Center in New York.

When performed by the hands of experienced prostate cancer surgeons at a center of excellence, laparoscopic radical prostatectomy (LRP) and open retropubic radical prostatectomy (RRP) are associated with comparable outcomes in the treatment of clinically localized prostate cancer, according to findings reported by urologists from Memorial Sloan-Kettering Cancer Center in New York.

The single-center investigation reviewed prospectively collected data from 1,431 men who were consecutively operated on between Jan. 1, 2003, and Dec. 31, 2005. Surgical approach was selected by the patient; 613 men had the minimally invasive procedure, and 818 men underwent open surgery.

Men who underwent LRP had significantly less blood loss compared with that of the open surgery patients (314 mL vs. 1,267 mL) and a significantly lower transfusion rate (2.9% vs. 49%). The positive margin rate was 11.3% in both groups, and after a median follow-up of 12 months, 97% of LRP patients and 96% of RRP patients were free of biochemical recurrence.

Among men who were potent preoperatively, just over three-fourths in each surgical group were potent 12 months after bilateral nerve-preserving surgery. However, recovery of continence, within the limits of this study, was significantly better after RRP compared with LRP. At 12 months, 79% of RRP patients and 59% in the RRP group were pad free or without leakage, researchers reported at the AUA annual meeting.

"To our knowledge, this is the first study that compares outcomes after open and laparoscopic radical prostatectomy for treatment of clinically localized prostate cancer in contemporary and contemporaneous groups in a single center where the expertise of the surgeons is internationally recognized of being at the highest level," said first author Karim Touijer, MD.

"At least for men operated on at our institution, it appears the laparoscopic approach offers some short-term advantages with respect to morbidity. However, considering the primary quality indicators of oncological and functional outcomes over the longer term, the two procedures are comparable, except recovery of continence was faster in the open group," he told Urology Times.