Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial

Abstract

Background: The adoption of robot-assisted laparoscopic radical prostatectomy (RALP) has increased rapidly, despite lack of conclusive evidence of its superiority regarding long-term outcomes over open retropubic RP (RRP). In 2015, we reported on 12-mo follow-up from the LAPPRO trial showing a moderate advantage of RALP regarding erectile dysfunction. No significant differences were seen for urinary incontinence or surgical margin status.

Objective: To present patient-reported functional outcomes and recurrent and residual disease at 24-mo follow-up from the prospective multicenter LAPPRO trial.

Design, setting, and participants: A total of 4003 patients with clinically localized prostate cancer were recruited from 14 Swedish centers, seven performing RALP and seven RRP.

Outcome measurements and statistical analysis: Data were only analyzed for patients operated on by surgeons with >100 prior RPs. Adjusted odds ratios (AORs) were calculated using logistic regression, with adjustment for differences in patient mix.

Results and limitations: At 24 mo, there was a significant difference in erectile dysfunction in favor of RALP (68% vs 74%; AOR 0.72, 95% confidence interval [CI] 0.57-0.91; p=0.006). No significant difference was observed for incontinence (19% vs 16%; AOR 1.29, 95% CI 1.00-1.67; p=0.053) or recurrent or residual disease (13% vs 13%; AOR 0.79, 95% CI 0.59-1.07; p=0.13). We did not adjust for individual surgeon volume and experience, which is a potential limitation.

Conclusions: Extended follow-up corroborated our previous report at 12 mo of a persistent RALP benefit regarding potency.

Patient summary: LAPPRO is a Swedish trial comparing two different prostate cancer surgical techniques (robotic compared to open). At 24-mo follow-up after surgery there was a moderate advantage for the robotic technique regarding erectile dysfunction (potency), while there was a small but not significant difference in urinary leakage in favor of open surgery. We did not find any difference regarding cancer relapse.

Keywords: Biochemical recurrence; Erectile dysfunction; Open radical prostatectomy; Prostate cancer; Robot-assisted laparoscopic radical prostatectomy; Urinary incontinence.

Fig. 1 -

Flow chart for enrollment. Numbers may not sum properly as the same participant may have fulfilled more than one exclusion criterion. PSA = prostate-specific antigen.

Fig. 2 -

Forest plots showing the adjusted odds ratio and 95% confidence interval for comparison between robot-assisted laparoscopic prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) for each 24-mo outcome. Adjustments for urinary incontinence and erectile dysfunction are A + B as described in Table 2. Results are presented on a logarithm scale. BCR = recurrent or residual disease.