CEM15: Benefits of open, robot-assisted radical prostatectomy are equal

Robot-assisted radical prostatectomy (RARP) is increasingly edging out open surgery but the benefits between the two procedures are the same except for less blood loss which favors the robotic procedure.

In a lecture and follow-up discussion on the issue, participants at the 15th Central European Meeting (CEM) which opened today in Budapest, Hungary, examined both open and robot-assisted RP with H. Lepor (USA) emphasizing in his lecture that savvy marketing has largely promoted the increasing popularity of robot-assisted radical prostatectomy.

“The robot is a bad investment in terms of improving outcomes. The only benefit of robotic RP is less blood loss,” Lepor said in his concluding remarks.

During the ensuing discussion, Lepor added the practice of radical prostatectomy was “transformed not on the basis of outcomes but due to savvy marketing.” “The preponderance of evidence shows no inherent advantage of robotic RP as it relates to length of stay or even pain.,” he added.

In his talk, Lepor said studies comparing the two techniques should not rely on single-surgeon studies but should focus instead on disease and patient characteristics. “These factors, plus the hospital setting, clinical pathways and outcome assessments should be equivalent,” explained Lepor as he drove home the point that citing single-surgeon experiences led to skewed conclusions which seem to favor robot-assisted RP.

There were dissenting opinions expressed by some in the audience with Prof. Gunter Janetschek offering a contrary view with regards the technical benefits that surgeons derive from the robotic procedure.

Lepor reiterated his arguments and added that some studies even showed that there is greater dissatisfaction rates shown by patients due to unrealistic expectations.

Meanwhile, speakers Peter Tenke (HU) and Janetschek discussed the role of intraoperative frozen section analysis during laparoscopic RP and new techniques in pelvic node dissection in prostate cancer, respectively.

“The oncological outcome of intrafascial nerve sparing technique is a safe as the classical nerve-sparing technique, but it has also improved early incontinence and potency,” said Tenke. “If the conditions are suitable for nerve-sparing, intrafascial technique is recommended.”

Janetschek, meanwhile, in his overview lecture on pelvic node dissection said that blind pelvic lymph node dissection (PLND) should be replaced by targeted PLND. He also noted that indocyaningreen (ICG) is better than TC99 when employing procedures such as fluorescence-targeted PLND for prostate cancer.