Laparoscopic versus open radical retropubic prostatectomy: a case-control study at a single institution

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Open retropubic prostatectomy (RRP) has been the standard surgical treatment for prostate cancer.
• Laparoscopic extraperitoneal radical prostatectomy (LRP) offers a minimally invasive alternative.
• Comparing outcomes between RRP and LRP is crucial for surgical decision-making.

Purpose of the Study:

• To compare the outcomes of open retropubic prostatectomy (RRP) versus laparoscopic extraperitoneal radical prostatectomy (LRP).
• To evaluate operative data, complications, pathological outcomes, and mid-term oncological results.
• To determine the preferred surgical approach for radical prostatectomy at the institution.

Main Methods:

• Retrospective comparison of 50 patients undergoing RRP and 50 patients undergoing LRP.
• Focus on operative time, blood loss, transfusion rates, lymph node dissection, complications, catheter time, continence, positive margins, and oncological recurrence.
• Follow-up extended up to 7 years, with a mean of 24 months for oncological outcomes.

Main Results:

• LRP group showed significantly lower mean blood loss (800 cc vs. 1150 cc) and transfusion rates (19.6% vs. 55.7%).
• Median catheter time was shorter for LRP (8.9 days vs. 22 days), with similar 12-month continence rates (91.7% vs. 90.3%).
• Oncological outcomes, including positive margin rates (7.0% vs. 8.2%) and PSA recurrence (10% vs. 10%), were equivalent between groups.

Conclusions:

• Laparoscopic radical prostatectomy (LRP) demonstrates advantages in reduced blood loss, transfusion rates, and faster recovery of continence.
• While RRP has a shorter operative time, LRP is technically demanding with a learning curve.
• LRP is increasingly favored due to overall improved patient outcomes, becoming the method of choice at the institution.