Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005 Journal Article


Authors: Touijer, K.; Eastham, J. A.; Secin, F. P.; Romero Otero, J.; Serio, A.; Stasi, J.; Sanchez Salas, R.; Vickers, A.; Reuter, V. E.; Scardino, P. T.; Guillonneau, B.
Article Title: Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005
Abstract: Purpose: In a nonrandomized prospective fashion we compared the oncological, functional and morbidity outcomes after laparoscopic and retropubic radical prostatectomy. Materials and Methods: Between January 2003 and December 2005 a total of 1,430 consecutive men with clinically localized prostate cancer underwent radical prostatectomy, laparoscopic in 612 and retropubic in 818. The surgical approach was selected by the patient. Preoperative staging, respective surgical techniques, pathological examination and followup were uniform. Functional outcome was measured by patient completed health related quality of life questionnaire. Results: Positive surgical margin rates (11%) and freedom from progression (median followup 18 months) were comparable between laparoscopic and retropubic radical prostatectomy (HR 0.99 for laparoscopic vs retropubic radical prostatectomy, p = 0.9). We found no significant association between operation type and time to postoperative potency (HR 1.04 for laparoscopic vs retropubic radical prostatectomy; 95% CI 0.74, 1.46; p = 0.8). Patients who underwent laparoscopic radical prostatectomy were less likely to become continent than those treated with retropubic radical prostatectomy (HR 0.56 for laparoscopic vs retropubic radical prostatectomy; 95% CI 0.44, 0.70; p <0.0005). Laparoscopic radical prostatectomy was associated with less blood loss (mean ml ± SD 315 ± 186 vs 1,267 ± 660) and lower overall transfusion rate (3% vs 49%). No significant difference was noted in cardiovascular, thromboembolic and urinary complications. Emergency room visits and readmissions were higher after laparoscopic radical prostatectomy (15% vs 11% and 4.6% vs 1.2%, respectively). Conclusions: At our institution and during the study period laparoscopic radical prostatectomy and retropubic radical prostatectomy provided comparable oncological efficacy. Laparoscopic radical prostatectomy was associated with less blood loss and a lower transfusion rate, and higher postoperative hospital visits and readmission rate. While the recovery of potency was equivalent, that of continence was superior after retropubic radical prostatectomy. © 2008 American Urological Association.
Keywords: controlled study; human tissue; treatment outcome; surgical technique; major clinical study; cancer localization; cancer growth; cancer staging; follow up; lymphatic metastasis; pelvis; laparoscopy; laparoscopic surgery; prospective study; quality of life; bleeding; pathology; prostate cancer; prostatic neoplasms; emergency ward; length of stay; sexual dysfunction; urine incontinence; prostatectomy; thromboembolism; blood transfusion; surgery; intermethod comparison; blood loss, surgical
Journal Title: Journal of Urology
Volume: 179
Issue: 5
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2008-05-01
Start Page: 1811
End Page: 1817
Language: English
DOI: 10.1016/j.juro.2008.01.026
PUBMED: 18353387
PROVIDER: scopus
PMCID: PMC3622224
DOI/URL:
Notes: --- - "Cited By (since 1996): 53" - "Export Date: 17 November 2011" - "CODEN: JOURA" - "Source: Scopus"
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MSK Authors
  1. Peter T Scardino
    660 Scardino
  2. Fernando Pablo Secin
    54 Secin
  3. Karim Abdelkrim Touijer
    231 Touijer
  4. Andrew J Vickers
    713 Vickers
  5. Angel M Cronin
    145 Cronin
  6. James Eastham
    495 Eastham
  7. Victor Reuter
    1163 Reuter
  8. Jason Stasi
    26 Stasi