Introduction

Whether surgeons perform better utilizing a robot-assisted laparoscopic technique compared to an open approach during prostate-cancer surgery, is hotly debated. To understand pros and cons of respective techniques, we need more data separating results for high and low-risk tumors.

Methods

In a prospective trial we recruited men with prostate cancer from seven open and seven robot-assisted surgery study centers (2008-2011). Information on patient-reported erectile-function was collected before, three, 12 and 24 months after surgery. Urologists reported the degree of neurovascular-bundle preservation. Pathologists assessed rates of positive surgical margins. Biochemical recurrence rate was measured at three, 12 and 24 months.

Results

We have information from 2545 men (1792 robot-assisted and 743 open surgery). Among 1702 preoperatively potent men, we found enhanced erectile-function recovery in the robot-assisted group at three months with smaller differences at 12 and 24 months. For patients with high-risk tumors, point estimates for erectile-function recovery were higher in the open-surgery group. Correlations between the degree of neurovascular bundle preservation and erectile-function recovery were greater for robot-assisted surgery. In prostate-confined tumors, 10.2 versus 17.0 percent positive surgical margin rates were observed for open and robot-assisted surgery, respectively (adjusted RR 0.59; 95%CI 0.45-0.79); corresponding figures for non-prostate-confined tumors were 48.1 percent and 33.3 percent (adjusted RR 1.42; 95%CI 1.17-1.74). Differences in two-year biochemical recurrence between open and robot cohorts were seen in the non-prostate-confined tumors (adjusted RR 1.66; 95%CI 1.17-2.36) but not in prostate-confined tumors.

Conclusions

When comparing robot-assisted laparoscopic surgery with open surgery, tumor characteristics distinguish the results for erectile-function recovery and oncologic outcome in opposite directions. This observation highlights possibilities to improve the plane of surgery irrespective of technique used.

Funding

None