Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2008 May;179(5):1811-7; discussion 1817.
doi: 10.1016/j.juro.2008.01.026. Epub 2008 Mar 18.

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

Karim Touijer  1 , James A Eastham, Fernando P Secin, Javier Romero Otero, Angel Serio, Jason Stasi, Rafael Sanchez-Salas, Andrew Vickers, Victor E Reuter, Peter T Scardino, Bertrand Guillonneau
Affiliations
Comparative Study

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

Karim Touijer et al. J Urol. 2008 May.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Predicted probability of positive surgical margins by preoperative risk, by operation type, with 95% confidence intervals. Black lines: RRP; Gray lines: LRP.
Figure 2
Figure 2
Predicted probability of positive surgical margin by surgeon experience, separately for lap and open, with adjustment for preoperative PSA and pathologic stage and grade. Estimates of PSM probability cannot be compared between groups as risk adjustment was within group only. Black lines: RRP; Gray lines: LRP.
Figure 3
Figure 3
Kaplan-Meier recurrence-free probability by operation type. Black lines: RRP; Gray lines: LRP.
Figure 4
Figure 4
Cumulative incidence of continence by operation type. Black lines: RRP; Gray lines: LRP.
Figure 5
Figure 5
Cumulative incidence of overall potency by operation type. Black lines: RRP; Gray lines: LRP.
See this image and copyright information in PMC

References

    1. Kattan MW, Eastham JA, Stapleton AM, Wheeler TM, Scardino PT. A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst. 1998;90:766. - PubMed
    1. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol. 2000;163:1643. - PubMed
    1. Touijer AK, Guillonneau B. Laparoscopic radical prostatectomy. Urol Oncol. 2004;22:133. - PubMed
    1. Eastham JA, Scardino PT. Radical prostatectomy for clinical stage T1 and T2 prostate cancer. In: Vogelzang NJ, Scardino PT, Shipley WV, et al., editors. Comprehensive Textbook of Genitourinary Oncology. 2nd ed. Baltimore: Williams & Wilkins; 1996. pp. 722–738.
    1. Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. Jama. 1997;277:1445. - PubMed

Publication types