Short-term Results after Robot-assisted Laparoscopic Radical Prostatectomy Compared to Open Radical Prostatectomy
Menée à partir de questionnaires auprès de 2 506 patients atteints d'un cancer de la prostate, cette étude compare, du point de vue de données intra-opératoires puis post-opératoires à 3 mois (durée de l'intervention et de l'hospitalisation, perte de sang, taux de réadmission, ...), la sécurité et les avantages de deux techniques de prostatectomie radicale, l'une par voie rétropubienne et l'autre par voie laparoscopique
Background : Robot-assisted laparoscopic radical prostatectomy has become a widespread technique despite a lack of randomised trials showing its superiority over open radical prostatectomy. Objective : To compare in-hospital characteristics and patient-reported outcomes at 3 mo between robot-assisted laparoscopic and open retropubic radical prostatectomy. Design, setting, and participants : A prospective, controlled trial was performed of all men who underwent radical prostatectomy at 14 participating centres. Validated patient questionnaires were collected at baseline and after 3 mo by independent health-care researchers. Outcome measurements and statistical analysis : The difference in outcome between the two treatment groups were analysed using logistic regression analysis, with adjustment for identified confounders. Results and limitations : Questionnaires were received from 2506 (95%) patients. The robot-assisted surgery group had less perioperative bleeding (185 vs 683 ml, p < 0.001) and shorter hospital stay (3.3 vs 4.1 d, p < 0.001) than the open surgery group. Operating time was shorter with the open technique (103 vs 175 min, p < 0.001) compared with the robot-assisted technique. Reoperation during initial hospital stay was more frequent after open surgery after adjusting for tumour characteristics and lymph node dissection (1.6% vs 0.7%, odds ratio [OR] 0.31, 95% confidence interval [CI 95%] 0.11–0.90). Men who underwent open surgery were more likely to seek healthcare (for one or more of 22 specified disorders identified prestudy) compared to men in the robot-assisted surgery group (p = 0.03). It was more common to seek healthcare for cardiovascular reasons in the open surgery group than in the robot-assisted surgery group, after adjusting for nontumour and tumour-specific confounders, (7.9% vs 5.8%, OR 0.63, CI 95% 0.42–0.94). The readmittance rate was not statistically different between the groups. A limitation of the study is the lack of a standardised tool for the assessment of the adverse events. Conclusions : This large prospective study confirms previous findings that robot-assisted laparoscopic radical prostatectomy is a safe procedure with some short-term advantages compared to open surgery. Whether these advantages also include long-term morbidity and are related to acceptable costs remain to be studied. Patient summary : We compare patient-reported outcomes between two commonly used surgical techniques. Our results show that the choice of surgical technique may influence short-term outcomes.