Robot-assisted radical prostatectomy vs. open radical prostatectomy

Abstract

Purpose of review Despite increasing use of robotic surgery for radical prostatectomy, the benefit of robotic over open approach on different postoperative outcomes is still under debate. The present review aimed to provide a framework on the latest evidences on outcomes of prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP) vs. open radical prostatectomy (ORP). Specifically, we focused on postoperative complications, urinary continence and erectile function recovery, PCa recurrence and PCa-related mortality. Recent findings Regarding perioperative outcomes, recent studies confirmed lower blood loss, transfusion rates and shorter catheterization time for RARP compared with ORP. Postoperative complications are lower in retrospective analyses, but this trend was not confirmed in prospective studies. Functional outcomes are comparable between RARP and ORP, with a slight nonclinically meaningful benefit in favour of RARP. The mid-term update of a recent randomized trial showed better oncological outcomes at 24 months, but the strength of this finding is limited by methodological flaws. Conversely, contemporary retrospective studies did not demonstrate differences in terms of biochemical recurrence between the two surgical approaches. Summary The recent large uptake of RARP relative to ORP was sustained by evidences showing improved perioperative outcomes but not clear benefit on functional and oncological outcomes.