Comparative analysis of the outcomes of laparoscopic radical prostatectomy and initial experience with robot-assisted radical prostatectomy

BACKGROUND: Robot-assisted radical prostatectomy (RARP) offers advantages over open and laparoscopic approaches, including superior visualization and enhanced surgeon ergonomics. This study analyzed the short-term outcomes of the first RARP performed at the N.N. Petrov National Medical Research Center of Oncology, comparing them with laparoscopic radical prostatectomy (LRP).

AIM: To compare the outcomes of RARP and LRP in patients with clinically localized prostate cancer of low and favorable intermediate risk.

MATERIALS AND METHODS: The study included patients who underwent radical prostatectomy (RP) for localized prostate cancer of low and favorable intermediate risk (according to the NCCN classification) between 2022 and 2023. The final cohort consisted of 49 patients who underwent LRP and 58 patients who underwent RARP.

RESULTS: There were no significant differences between the groups in the incidence of early postoperative complications. However, positive surgical margins were significantly more frequent in the RARP group (51.7%) than in the LRP group (20.4%). Urethral catheter removal occurred earlier in the LRP group (median: 4 days) than in the RARP group (median: 6 days). At six months postoperatively, erectile function, including with conservative therapy, was preserved in 36.4% of patients after RARP and in 21.4% after LRP (χ² = 0.202). Severe urinary incontinence was observed in 3.5% of patients in the LRP group and 12.5% in the RARP group (χ² = 0.249).

CONCLUSIONS: The study demonstrated a significantly lower rate of positive surgical margins following LRP compared to RARP. However, it should be noted that the RARP group included patients operated on at the N.N. Petrov National Medical Research Center of Oncology during the initial implementation of this technique, which may have influenced the outcomes. Further studies are required.