Experienced surgeons get similar outcomes using RALP or ORP

According to data presented by Stephenson et al. at the annual winter meeting of the Society of Urologic Oncology, a prospective study of more than 350 prostate cancer patients over a 2-year period shows that continence and sexual function are similar after robotic-assisted laparoscopic radical prostatectomy (RALP) and open radical prostatectomy (ORP).

Unfortunately, the only public information about this study that we have to go on at the present time is the media release issued by the Cleveland Clinic, where this study was carried out. However, this set of study results is hardly a surprise. All the operations were carried out by “high-volume experienced surgeons in their field” at high-volume hospitals. One would reasonably expect skilled and highly experienced surgeons at high-volume centers to get similar results like this, and all that the study really tells us, therefore (as the authors note), is that, “the technical skill of the surgeon appears to be a major determinant of a successful outcome.”

The only actual data provided about this study to date are the following:

  • 361 patients were enrolled in the study.
  • 190/361 patients (52.6 percent) were treated surgically by RALP.
  • 171/361 patients (47.4 percent) were treated surgically by ORP.
  • All 361 patients completed a validated quality-of-life survey including information about urinary continence and sexual function at baseline and at 1, 3, 6, 12, and 24 months post-surgery.
  • Whether patients had RALP or ORP, they reported similar quality-of-life outcomes.
  • Although urinary continence at 2 years was similar after RALP and ORP, patients treated by RALP apparently “experienced a slightly slower return to continence.”

What we do not know from the information provided in the media release is either the level of continence achieved or the degree to which patients recovered their baseline sexual function at any point post-surgery. We also have to assume that the 371 men included in this study had localized prostate cancer, but we have no data on their age, their risk level. their stage, the pre-surgical PSA levels, etc.

2 Responses

  1. My own surgeon reserves RALP for lower-risk patients, preferring open surgery for those with palpable tumors. If this is a widespread practice (I have no idea) the study might be a case of apples vs oranges.

    But yet another blow against gizmo idolatry and Intuitive.

  2. There is no standard practice that I am aware of. It is much more a case of individual physician preference. My suspicion would be that in the Cleveland Clinic study some surgeons were doing RALPs almost regardless of clinical stage and some were doing ORPs.

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