Is Laparoscopic Radical Prostatectomy Better Than Traditional Retropubic Radical Prostatectomy?

Abstract

Objective: To compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period.

Patients and Methods: The clinical and pathological data obtained in 50 consecutive patients who underwent retropubic radical prostatectomy (RRP) from January 2001 to December 2001 were compared to those obtained in 71 consecutive patients who were treated in the same year by extraperitoneal laparoscopic radical prostatectomy (LRP). The two groups were comparable in terms of mean pre-operative PSA and biopsy Gleason score. The peri-operative data included operative time, intra-operative and post-operative transfusion rates, complication rates, hospitalization length, and duration of catheterization. The following pathological parameters were considered: Gleason score, pathological stage, and positive surgical margin rate. A comparative evaluation of continence recovery (no pads and any leakage) was made only in patients with follow-up longer than 12 months.

Results: The two groups were comparable in terms of pathological stage and definitive Gleason score. Operating times were significantly shorter in RRP (p<0.0001). LRP patients showed higher autologous (p<0.001) and eterologous transfusion (p=0.03). No significant difference was observed in terms of complication rates (p=0.07). The rectal injury rate was 2.8% in the laparoscopic group. The mean post-operative hospital stay was 10.2±2 days in the surgery group and 7.2±3.4 days in the laparoscopy group (p<0.001). Catheterization time was 8.4±0.9 days in the surgery group and 8±2.8 days in the laparoscopy group (p=0.27). After 12 months, complete continence was achieved in 64% of RRP and 40% of LRP patients, respectively (p=0.29).

Conclusion: The results of our non-randomized study show that up to now laparoscopic radical prostatectomy does not provide significant advantages in terms of peri-operative morbidity compared with the traditional retropubic approach.

Introduction

Radical retropubic prostatectomy (RRP) is currently the “gold standard” of surgical treatment for clinically localized prostate cancer. This surgical technique was first described by Millin in 1945 and has since gained widespread application worldwide, particularly in its “anatomic” version, which was described by Walsh et al. in 1983 [1]. Over the years, there has been a significant reduction in the morbidity and mortality associated with this procedure [2]. The oncological efficacy of RRP has been shown by several clinical trials with long-term follow-up [3], [4], [5].

The first extraperitoneal laparoscopic radical prostatectomy was reported by Raboy et al. in 1997 [6]. During the same year, Schussler et al. published the results of nine transperitoneal laparoscopic radical prostatectomies [7]. The long operative times and the associated complication rates reported were a limit of the technique until 1999, when technical improvements allowed shorter operating times [8].

Up to now, the published papers have shown the feasibility of laparoscopic radical prostatectomy (LRP) and led to increasing interest in this modern approach to localized prostate cancer treatment. According to those who support laparoscopy, it can reduce treatment morbidity, hospitalization and, because of the optical magnification, it can be a potential advantage in terms of continence and erectile function preservation [9], [10], [11], [12]. LRP is currently a reasonable alternative in the treatment of localized prostate cancer. However, whether this new technique is better than traditional RRP is still unclear. In our opinion the answer cannot be given on the basis of clinical studies, which compare modern LRP to historical RRP group [13].

The aim of this paper is to compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period.