Point: open radical prostatectomy should not be abandoned.

Area of Science:

• Urology
• Surgical Oncology

Background:

• Robotic-assisted laparoscopic radical prostatectomy is a prevalent treatment for prostate cancer.
• While effective, the advantages of the laparoscopic approach may be overstated in certain clinical scenarios.

Purpose of the Study:

• To evaluate the continued role and specific advantages of open radical prostatectomy compared to robotic-assisted laparoscopic radical prostatectomy.
• To highlight scenarios where the open technique may offer superior outcomes or feasibility.

Main Methods:

• Comparative analysis of open versus robotic-assisted laparoscopic radical prostatectomy techniques.
• Discussion of specific surgical aspects such as lymphadenectomy, tactile sensation, and patient selection criteria.

Main Results:

• Open radical prostatectomy facilitates more extensive lymphadenectomy, crucial for staging and treatment of high-risk prostate cancer.
• Tactile sensation, vital for assessing local tumor extent, is currently superior in the open approach.
• Obese patients, those with prior extensive surgery, or extremely large prostates may benefit more from the open technique.
• The open approach presents a significant advantage in terms of hospital costs.

Conclusions:

• Open radical prostatectomy retains a significant role in prostate cancer management, particularly for specific patient groups and surgical requirements.
• The perceived universal superiority of robotic approaches may overlook the distinct advantages offered by the open technique.
• Further research and clinical consideration should acknowledge the benefits of open surgery in terms of oncologic control, surgical assessment, and cost-effectiveness.