Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

Abstract

Aim. To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods. 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results. Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>p</a:mi></a:math> &lt; 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>p</c:mi></c:math> = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"><e:mi>p</e:mi></e:math> = 0.192 and <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"><g:mi>p</g:mi></g:math> = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"><i:mi>p</i:mi></i:math> = 0.013 and <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"><k:mi>p</k:mi></k:math> = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"><m:mi>p</m:mi></m:math> = 0.228). Conclusions. For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.