Robot-assisted laparoscopy meets open radical prostatectomy for functional outcomes
medwireNews: Phase III trial findings suggest that men who require radical prostatectomy for localised prostate cancer achieve similar functional outcomes at 2 years, regardless of whether they undergo robot-assisted laparoscopic surgery or an open radical retropubic procedure.
The 157 men who were randomly assigned to receive laparoscopic surgery achieved comparable average urinary function scores to the 151 patients who underwent open surgery at 6, 12, and 24 months, as measured using the urinary domain of the Expanded Prostate Cancer Index Composite (EPIC).
This was also true at these time points for scores on both the sexual domain of EPIC and for the International Index of Erectile Functional Questionnaire, report Suzanne Chambers, from Griffith University in Gold Coast, Queensland, Australia, and co-investigators.
However, the team also found that the laparoscopic group were less likely to experience biochemical recurrence at 2 years – defined as a prostate-specific antigen level of 0.2 ng/mL or above – than their open surgery counterparts, at 3% versus 9%.
Additional analysis also failed to establish equivalence for biochemical recurrence between the treatment arms, but the researchers believe this finding is “surprising” as the laparoscopically treated men had a higher rate of positive margins (15 vs 10%). Also, the laparoscopic and open groups were comparable in terms of radiographical progression (1 vs 2%) and the likelihood of receiving at least one further treatment (10 vs 9%).
Writing in The Lancet Oncology, Chambers et al therefore “advise caution” in interpreting the biochemical recurrence finding, and emphasize that the study design was not powered to detect oncological outcome differences and did not account for differences in postoperative tumour management.
The authors of an accompanying comment write that “the overall narrative of criticism against the trial can be distilled down to concerns regarding the lack of generalisability of both the open and robotic surgeries untaken”.
Vidit Sharma and R Jeffrey Karnes, from the Mayo Clinic in Rochester, Minnesota, USA, explain that the surgeries were performed by a single surgeon in each arm and that the differences in experience with the laparoscopic and open techniques prior to the trial (200 vs 1500 procedures per surgeon) may confer “learning curve disparities”.
Agreeing that the oncological results are “preliminary”, the commentators conclude: “The gold standard for prostate cancer surgery remains a high quality radical prostatectomy, regardless of the approach.”
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