Comparison of Functional and Oncological Outcomes in Open, Video Laparoscopic, and Robotic Prostatectomy at a Sistema Único de Saúde Facility
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2024.210394Keywords:
Prostate cancer, Open radical prostatectomy, Robotic assisted radical prostatectomy, Laparoscopic radical prostatectomy, Positive marginsAbstract
Introduction: Prostate cancer is the second most common cancer worldwide among men. Among the various therapeutic modalities, radical prostatectomy is the primary treatment option, which can be performed using the following techniques: retropubic (RRP), perineal (RPP), video laparoscopic (VLP), and robot assisted (RALP). RALP has gained widespread use in urology, primarily due to its technical advantages and superior functional outcomes, such as the maintenance of urinary continence and the preservation of erectile function. However, the oncological outcomes of RALP are comparable to those of RRP and VLP. Objectives: To analyze the perioperative, functional, and oncological outcomes of prostatectomies performed via RRP, VLP, and RALP at a tertiary hospital in Curitiba, Paraná, Brazil. Methodology: The study included 367 patients diagnosed with prostate cancer who underwent radical prostatectomy between 2016 and 2021, with 221 patients undergoing RRP, 118 undergoing VLP, and 37 undergoing RALP. Preoperative clinical data and outcomes of interest were assessed through a retrospective analysis of medical records. Results: A lower frequency of sexual dysfunction was observed among patients who underwent RALP (p=0.039) and VLP (p<0.0001) compared to those who underwent RRP. However, the mean surgery time was longer for RALP compared to both RRP (p=0.001) and VLP (p=0.001). Regarding oncological outcomes, RALP demonstrated a higher frequency of free urethral margins (p=0.033). The other oncological, functional, and perioperative factors were statistically similar across the three types of surgery. Conclusion: RALP is associated with a shorter hospital stay and a lower rate of sexual dysfunction up to one year after prostatectomy, compared to RRP. The oncological
outcomes were generally equivalent across the techniques, with the exception of urethral margin status.
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Copyright (c) 2024 Teodora Roballo Durigan, Bruno Pandolfo Meneghete, Bárbara Casagrande Calomeno de Oliveira Mello, José Cassiano Koaski, Nikolai Cernescu Neto, Fabiana Antunes Andrade, Vinícius Basso Preti, Walter Guimarães da Costa Neto
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