NEW YORK (Reuters Health) – A French team reports some advantages with robot-assisted compared to conventional laparoscopic radical prostatectomy performed via an extraperitoneal approach.

“This study did not lead us to a definitive recommendation for the robot assistance approach, but it does suggest improved perioperative parameters and potency recovery without compromising oncologic control,” they conclude in their paper in European Urology online December 3.

There have been several studies investigating outcomes of robot-assisted laparoscopic prostatectomy, or RALP. (See, for example, Reuters Health reports “Robotic laparoscopic prostatectomy offers advantages: study” on October 27, 2011, and “Robotic surgery for prostate cancer may improve functional outcome,” on July 31, 2009.) However, the authors of the current study point out that “no level 1 evidence-based benefit favouring RALP versus pure laparoscopic approaches has been demonstrated in extraperitoneal laparoscopic procedures.”

To investigate that aspect, Dr. Guillaume Ploussard and colleagues at Hospital Henri Mondor in Creteil reviewed their experience performing 2386 laparoscopic radical prostatectomies using an extraperitoneal approach. The first-generation da Vinci robotic system was used in 1009 of the operations while the other 1377 were conventional laparoscopic radical prostatectomies (LRP).

Operative time was significantly shorter with RALP (129 minutes) than with LRP (175 minutes), the team reports, and mean blood loss was 515 mL versus 800 mL in the two arms, respectively. Length of stay was 4.0 days with RALP compared with 5.7 days with LRP.

“The overall rate and the severity of complications did not differ between the two groups,” the report states.

Overall, margin positivity in pT2 disease was not significantly different in the two arms – 19.6% in the RALP group versus 16.8% in the LRP group (p=0.513), according to the data. On multivariate analysis, positive margin rates were shown to be lower in the RALP group (odds ratio 0.396; p=0.030).

PSA failure rates were not significantly different at 10.3% with RALP versus 18.0% with LRP (p=0.753).

As for side effects, potency recovery at 12 months was more likely in the RALP arm than in the LRP arm (odds ratio 5.9; p=0.045). However, the surgical approach did not affect continence recovery (odds ratio 2.01; p=0.253).

Discussing the results, Dr. Ploussard and colleagues comment, “Our results were in line with those published by ‘‘transperitoneal’’ surgeons. RALP offered advantages concerning the perioperative parameters in terms of hospital stay, operative time, and blood loss.”

They add, “Urologists performing RALP tend to expand indications of nerve preservation exposing patients selected on nonstringent criteria to an increased risk of positive margins. However, when strict indications of nerve-sparing techniques are respected, RALP does not increase the rate of positive margins.”

SOURCE: Comparisons of the Perioperative, Functional, and Oncologic Outcomes After Robot-Assisted Versus Pure Extraperitoneal Laparoscopic Radical Prostatectomy