Comparison of short-term complications after open, laparoscopic and robot-assisted radical prostatectomy

The objective of this study is to address the lack of real-life study comparing the impact of the three surgical approaches for radical prostatectomy (RP), i.e., open (ORP), laparoscopic (LRP) and robot-assisted (RARP), on the occurrence of postoperative events by measuring the association between surgical approach and risk of death, transfer to an intensive care unit (ICU), or complications during hospitalisation for RP.

This study used the French National Health Data System (Système National des Données de Santé [SNDS]) to study the 38 481 patients who underwent a RP in French hospitals in 2020-2021. The primary endpoint was the occurrence of any event (death, ICU admission, or complications) during hospitalisation for RP. Secondary endpoints were the occurrence of death, ICU admission, complications, and each of the complication subtypes. Outcomes were analysed by uni- and multivariable logistic regression.

A RARP was associated with the lowest risk of an event during hospitalisation, followed by LRP compared with ORP (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.48-0.55; and aOR 0.63, 95% CI 0.58-0.68, respectively). RARP was associated with a reduction in the risk of most complications compared with ORP. Minimally-invasive procedures were associated with an increased risk of hernia. To the best of our knowledge, this is the first French nationwide study of its sort and limitations are related to the observational nature of our study, the use of a medico-administrative database, and the length of follow-up. To confirm the main results 30-day sensitivity analyses were performed.

There were significantly fewer short-term postoperative events for RARP. Additional studies with a longer follow-up period are required to investigate the medium- and long-term risks.