Touijer K., Romero Otero J., Secin F.P., Sanchez Salas R., Stasi J., Eastham J.A., Scardino P.T., Guillonneau B.

Presented on March, 23 2007

INTRODUCTION & OBJECTIVES: To compare in a non-randomized prospective fashion the oncological, functional, and morbidity outcomes after open and laparoscopic radical prostatectomy.

MATERIAL & METHODS: Between January 1^st, 2003 and December 31^st, 2005, 1431 consecutive men with clinically localized adenocarcinoma of the prostate underwent radical prostatectomy at the same institution, 613 laparoscopically and 818 through a retropubic approach. The surgical approach was selected by the patient. The preoperative disease staging, the surgical planning and respective surgical techniques were uniform amongst all surgeons. Specimens were processed in a whole mount step sections and read by a referee genitourinary pathologist. Functional outcome was measured by a patient-filled health related quality of life questionnaire. Complications were graded according to the institution’s complication severity grading system.

RESULTS: Oncological outcome.  The median number of lymph nodes retrieved (14 vs. 12, p=0.08), lymph node metastasis rate (6% vs. 5.9%, p=0.96) and positive surgical margin rates (11.3%) were comparable for LRP and RRP respectively. The short-term biochemical recurrence data was also comparable with a median follow up of 12 months.
Functional outcome.  76% vs. 78% of the preoperatively potent patients were potent at 14 months following a bilateral nerve preserving LRP and RRP respectively, and 90% vs. 92% were continent (pad free or no leakage).
Morbidity outcome. LRP was associated with lesser estimated blood loss (314 ml (+/- 186) vs. 1267 ml (+/- 660)), and overall transfusion rate (2.9% vs. 49%)  and no significant difference with regards to cardiovascular, thrombo-embolic, urinary or gastrointestinal complication was noted between the two approaches.  Emergency room visits and readmissions were higher in the LRP group (15.5% vs. 10.8% and 4.7% vs. 1.2% respectively).

CONCLUSIONS: In our institution and during the study period, laparoscopic and retropubic radical prostatectomy provided comparable oncological efficacy, functional and morbidity outcomes.
The laparoscopic approach was associated with lesser blood loss and transfusion rate and higher postoperative hospital visits and readmission rate.

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