Risk of Recurrent Disease 6 Years After Open or Robotic-assisted Radical Prostatectomy in the Prospective Controlled Trial LAPPRO
Year: 2020
Type: article
Abstract: Conclusive evidence of superiority in oncological outcome for robot-assisted laparoscopic prostatectomy (RALP) over retropubic radical prostatectomy (RRP) is lacking. To compare RALP and RRP regarding recurrent disease and to report the mortality rate 6 yr after surgery. A total of 4003 men with localized prostate cancer were enrolled between 2008 and 2011 in Laparoscopic Prostatectomy Robot Open (LAPPRO)— a prospective, controlled, nonrandomized trial performed at 14 Swedish centers. Data were collected at visits and by patient questionnaires at 3, 12, and 24 mo, and through a structured telephone interview at 6 yr. Cause of death was retrieved from the National Cause of Death Register in Sweden. The modified Poisson regression approach was used for analyses. After adjustment for patient-, tumor-, and surgeon-related confounders, no statistically significant difference was observed between RALP and RRP in biochemical recurrence rate (14 vs 16%, relative risk [RR] 0.77, 95% confidence interval [CI] 0.56–1.06) or in not cured endpoint (22% vs 23%, RR 0.82, 95% CI 0.6–1.11). Stratified by D’Amico risk group, a significant benefit for RALP existed for recurrent disease in high-risk patients (RR 0.47, 95% CI 0.26–0.86, p = 0.02). All-cause mortality was 3% (n = 96). Prostate cancer–specific mortality was 0.6% (n = 21) overall, 0.3% (n = 8) after RALP, and 1.5% (n = 13) after RRP. The nonrandomized design is a limitation. No significant difference was observed for cancer recurrence rate between RALP and RRP 6 yr after surgery. However, in a subgroup analysis, we found a significant benefit for RALP regarding recurrence rate in the high-risk group. Larger studies with longer follow-up are needed to make a firm conclusion and to evaluate a possible survival benefit. In general, the oncological outcome is comparable between robotic and open radical prostatectomy 6 yr after surgery. For high-risk patients, our findings indicate that there is an advantage for robotics, but further studies with longer follow-up time is needed to make a firm conclusion.
Source: European Urology Open Science
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,800
Funders: Västra Götalandsregionen, Cancerfonden, Lunds Universitet, Vetenskapsrådet, Sahlgrenska Universitetssjukhuset, Anna och Edwin Bergers Stiftelse, Region Skåne, Stiftelsen Mary von Sydows, född Wijk, donationsfond, National Institutes of Health, Sidney Kimmel Center for Prostate and Urologic Cancers, National Cancer Institute
Awards: G1049766422, G1080400182, G1260840143, G1354514636, Minimally invasive surgical techniques in the treatment of prostate cancer and perforated diverticulitis of the colon., G1460704601, G1630954328, G1847337161, G1942552694, G2112060821, G2321040825, G2630796842, G27991797, G2829959283, G2968579139, G3077465227, G311881949, G3230715290, G3355816996, G3411532237, G342754289, G3581608288, Modeling Precision Interventions for Prostate Cancer Control, G3810440354, Minimally invasive surgical techniques in the treatment of prostate cancer and perforated diverticulitis of the colon., G390763727, G4030087922, G409292884, G4415063894, G4929415548, G5257441791, G5346337949, G5389341289, G5639005878, G5658937774, G5678467220, G5924605725, G661905352, G6682747084, G6819862027, G6868578847, G6998521297, G7296776764, G767046291, G7780350458, G7813559420, G7994605812, G8012251105, Modeling to Improve Prostate Cancer Outcomes Across Diverse Populations, G814704754, G8249561229, Improving shared decision making in cancer screening, G8668764002, G8706211370, G8793013406, Cancer Center Support Grant, SPORE in Prostate Cancer, G904371285
OpenAlex ID: W3064213779