According to a review published in the Journal of Urology, laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP) have similar rates of morbidity and similar requirements for additional therapy. However, LRP was associated with a significantly shorter hospitalization and a significantly lower incidence of bladder neck/urethral obstruction. In addition, more complications occurred when the surgeon was less experienced.
The New York-based researchers reviewed 5923 surgical cases from the Surveillance, Epidemiology, and End Results (SEER) cancer registry to help them evaluate differences in medical and/or surgical complications, length of hospital stay, and the need for radiation and/or androgen deprivation therapy. Of 5923 cases, 4858 (82%) were done by ORP and 1065 (18%) by LRP and all cases had been performed between 2003 and 2005. More than 60% of the men in both groups were between 66 and 69 years of age and 85% were white. Both groups had a similar distribution of prostate-specific antigen (PSA) and Gleason scores.
There were no differences in the rate of general medical or surgical complications within 90 days (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.77 to 1.14) or in complications affecting sexual, urinary, or bowel function within 365 days (OR, 0.96; 95% CI, 0.76 to 1.22). Similarly, there was little difference in the number of men in each surgery group who required postoperative radiation and/or hormone blockade therapy within 365 days (OR, 0.80; 95% CI, 0.60 to 1.08).
LRP was associated with a 35% shorter hospital stay (P<0.0001) and a lower rate of obstructions affecting the bladder neck and urethra (OR, 0.74; 95% CI, 0.58 to 0.94). In a subanalysis of the relationship between surgical experience and LRP, less experience was associated with more complications. A key limitation to this study was the fact that no information was available regarding which of the ORP procedures included robots.
Although ORP is regarded as the standard surgical treatment, LRP—with or without robotic assistance—is becoming more common as it is perceived as being superior in terms of hospital stay and reduced complications. In this study, LRP almost doubled in each successive year as a proportion of all procedures. However, given the similar outcomes for either procedure, the authors suggest that men considering radical prostatectomy be provided with information describing both procedures and discuss their concerns with an experienced surgeon.