EAU 2017: Quality of life after robotic, lap, and open surgery: real different?
London, England (UroToday.com) In this session, Dr. Graefen covered differences in robotic versus open surgery at the Martini Klinik in Hamburg, Germany. Comparing 20,000 open prostatectomy (RRP) cases to 5,000 robotic prostatectomy (RALP) cases, he noted no differences in oncologic outcome or urinary continence. There was a trend towards better continence rates with RALP. Morever, patients who underwent RALP had slightly fewer complications, less blood loss, and fewer transfusions compared to RRP. Moreover, data suggest that patients have a 3-fold increase in regret for treatment decision after RALP compared to RRP, which may be related to unrealistic expectations. However, it remains important to consider that patients from the RRP era may be different from more contemporary prostate cancer patients, thereby confounding results.
In concluding, he mentioned that surgical experience is more important than the approach. He advocated for finding an experienced surgeon with whom you have a rapport rather then becoming enamored with a style or tool. This is important because RALP and RRP achieve similar outcomes in experienced hands. Even still, there are unlikely to be long-term differences in oncologic outcome or continence rates. The improvements in complication rates and potency associated with RALP are hypothesis-generating and should be considered in the future. Lastly, Dr. Graefen extolled the virtues of quality assurance programs to improve surgical outcomes.
Presented by: M. Graefen, Hamburg, DE
Written by: Benjamin T. Ristau, MD, SUO Fellow, Fox Chase Cancer Center, Philadelphia, PA.
at the #EAU17 -March 24-28, 2017- London, England