Robotic versus Open Prostatectomy Provides Early Benefits for pT2

Robotic-assisted laparoscopic prostatectomy is associated with reductions in positive surgical margins, postoperative radiation therapy, and 30-day mortality, according to a study published in The Journal of Urology.

Shane M. Pearce, MD, from the University of Chicago Medicine and Biological Sciences, and colleagues compared outcomes for patients who underwent robotic-assisted laparoscopic prostatectomy (73,131 patients) and open radical prostatectomy (23,804 patients) for nonmetastatic prostate adenocarcinoma. The authors examined factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission, and 30-day mortality. Outcomes were compared in propensity matched cohorts.

The researcher found that propensity-matched cohort analysis showed a reduced risk of positive surgical margins, use of radiation therapy, and 30-day mortality with robotic-assisted laparoscopic prostatectomy (odds ratios, 0.88, 0.71, and 0.28, respectively; all P < .001). The protective effect on positive surgical margins was only seen for patients with pT2 disease (pT2: odds ratio, 0.85; 95% confidence interval, 0.79 to 0.91; pT3: odds ratio, 0.94; 95 percent confidence interval, 0.86 to 1.04).
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"In a contemporary large national cohort, robotic-assisted laparoscopic prostatectomy was independently associated with clinically meaningful reductions in positive surgical margins, postoperative radiation therapy, and 30-day mortality compared to open radical prostatectomy," the authors write. "The oncologic benefit was primarily in patients with organ confined disease."

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