Comparative analysis of surgical outcomes: open versus robot-assisted radical prostatectomy

To compare surgical complications, biochemical failure, and mortality rates between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP).

All men undergoing radical prostatectomy (1995-2023) at a single academic hospital were included, and preoperative factors, surgical parameters, complications, biochemical failures, and mortality were collected. Generalized linear models and cause-specific Cox regressions stratified by surgical procedure were used. Cumulative incidences of biochemical failure were estimated with the Aalen-Johansen estimator, accounting for death as a competing risk. Analyses of surgical complications were adjusted for age and lymphadenectomy, while positive surgical margins, biochemical failure, and mortality were adjusted for preoperative PSA, pathological lymph node stage, pT category, tumor percentage, ISUP score, age, and year of surgery.

A total of 3,477 men were included (ORP: 1,759; RARP: 1,718). RARP was associated with reduced odds of in-hospital complications (adjusted odds ratio [aOR]: 0.28, 95% confidence interval [CI]: 0.11-0.74). RARP was associated with a reduced risk of biochemical failure compared to ORP (unadjusted hazard ratio [HR]: 0.52, 95% CI: 0.29-0.93). No other outcomes or mortality rates differed significantly.

RARP was superior in terms of complications and non-inferior for oncological outcomes compared to ORP at our center. Although the only randomized trial yet, has not proven any significant improvement in long-term cancer control comparing the open versus robotic approach, RARP seems to have replaced ORP as the gold standard for surgical treatment of localized prostate cancer. However, the overall benefit of RARP in the surgical evolution remains elusive.