Master Theses UMCG - University of Groningen
English | Nederlands

A Comparison of Perioperative Outcomes Between Robot-Assisted Laparoscopic Prostatectomy And Retropubic Radical Prostatectomy for Prostate Cancer

(2017) Brummelstroete, G. te (Gerhard)

Prostate cancer is (when skin cancer is excluded) the leading cause of cancer in men and causes approximately 2500 deaths in the Netherlands each year. Several options are available in the treatment for organ-confined prostate cancer. From an oncological point of view, radical prostatectomy (RP) is often the preferred option. Open retropubic RP has been the gold standard for several years. The robot-assisted laparoscopic prostatectomy (RALP) was introduced over a decade ago and is still an increasingly popular approach. Recently, the Martini Hospital in Groningen purchased the newest version of the Da Vinci-robot. Although more evidence that RALP offers advantages over the open approach is becoming available, there is, in absence of randomized controlled trials, still discussion about the subject.
The goal of this study is to evaluate whether the robot-assisted prostatectomy offers perioperative advantages compared to the open prostatectomy in the early post-introduction phase.
Following approval of the Martini Hospital MEC, a database was created containing 197 patients who underwent radical prostatectomy. Preoperative patient characteristics such as age, weight, BMI, Charlson-score, ASA-score, iPSA, clinical stage, prostate volume and Gleason-score were collected. The two surgical approaches were then compared for blood loss, hospital stay, complications, postoperative pain, positive surgical margins and operation time. Statistical analysis was performed using independent t-tests, Mann-Whitney U-tests and chi-square-tests. To minimize the effect of confounding, instrumental variable analysis and multivariate logistic regression was performed.
No significant differences were observed in patient characteristics between the two groups. A significant difference was found for blood loss (RALP: 200 mL (IQR: 100-250) vs. RRP: 1100 mL (IQR: 775-1645)), hospital stay (RALP: 3 (IQR: 3-3,3) days vs RRP: 7 (IQR: 6-8) days), blood transfusions (RALP: n=0 vs. RRP: n=21) and operation time (RALP: 2:53 hours:min vs. RRP: 3:19 hours:min). There were significantly less observed positive surgical margins in robotic procedures for pT2-tumours (RALP: 9/76 vs. RRP: 26/68), but not for pT3-tumours (RALP: 12/20 vs. RRP: 13/28). A total of 118 complications occurred in 87 patients. Clavien grade I and II complications were more common in RRP-patients (n=72) than in RALP-patients (n=34).
Robot assisted prostatectomy offers significant advantages in terms of blood loss and length of hospital stay. More importantly, there were significantly less positive margins for pT2-tumours and less blood transfusions. No significant differences were found for number of patients with PSA >0,2 on 3 months and grade III/IV complications. The most apparent weakness of this study is the lack of information on functional outcomes.

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