ORP vs. RALP re-visited


A newly published report in The Lancet Oncology has pretty much finally confirmed what many of us have been assuming for a long time now: that open and robot-assisted laparoscopic forms of radical prostatectomy have very similar clinical outcomes — and that

Clinicians and patients should view the benefits of a robotic approach as being largely related to its minimally invasive nature.

The relevant data come from a paper by Coughlin et al. — an Australian clinical research group working at the Royal Brisbane and Women’s Hospital in Brisbane, Queensland.

This research team randomized 326 men with localized prostate cancer to either open surgery (ORP) or robot-assisted surgery (RALP) between 2010 and 2014 and then followed the patients for the next 24 months. Patient outcomes were formally evaluated at 6, 12, and 24 months post-surgery.

The basic study findings were as follows:

  • Patients’ ages ranged from 35 to 70 years
  • 163/326 men (50 percent) were initially randomized to ORP.
  • 163/326 men (50 percent) were initially randomized to RALP.
  • 18 patients withdrew from the study
    • 12 patients had been randomized to ORP
    • 6 had been randomized the RALP
  • 308 patients actually proceeded to have surgery
    • 151 in the ORP group
    • 157 in the RALP group
  • At 24 months of follow-up
    • 146/151 men (96.7 percent) were still being followed from the ORP group.
    • 150/157 men (95.5 percent) were still being followed from the RALP group.
  • Urinary function scores did not differ significantly between the ORP and the RALP groups over the course of the study.
    • At 6 months of follow-up, urinary scores were 88.45 for the ORP group and 88.68 for the RALP group.
    • At 12 months of follow-up, urinary scores were 91.53 for the ORP group and 90.76 for the RALP group.
    • At 24 months of follow-up, urinary scores were 90.86 for the ORP group and 91.33 for the RALP group.
  • Sexual function scores also did not differ significantly between the ORP and the RALP groups over the course of the study.
    • At 6 months post-surgery,
      • EPIC scores were 38.63 for the ORP group and 37.40 for the RALP group.
      • IIEF scores were 29.78 for the ORP group and 29·75 for the RALP group.
    • At 12 months post-surgery,
      • EPIC scores were 42.51 for the ORP group and 42.28 for the RALP group.
      • IIEF scores were 33.50 for the ORP group and 33.10 for the RALP group.
    • At 24 months post-surgery,
      • EPIC scores were 46.90 for the ORP group and 45.70 for the RALP group
      • IIEF scores were 33.89 for the ORP group and 33.95 for the RALP group.
  • There was a small difference between the numbers of patients having biochemical recurrences within the two groups:
    • 13/151 (9 percent) in the ORP group
    • 4/157 (3 percent) in the RALP group
    • It is not possible to confirm whether this is a statistically significant difference based on the number of patients in this study
    • Examination of the numbers of patients who had imaging evidence of progression revealed that the two groups were not significantly different.

The bottom line to this study is as follows:

  • ORP and RALP, when carried out by skilled practitioners of each technique, appear to have very similar functional and oncologic outcomes.
  • The small difference in oncologic outcomes could be associated with the absence of standardization in postoperative management between the two trial groups and the use of additional cancer treatments.
  • There are functional short-term benefits (in things like recovery time after surgery and other factors) associated with RALP as compared to ORP, but these do not appear to impact longer-term functional and oncologic outcomes.

The “New” Prostate Cancer InfoLink would once again emphasize that it is the skill and experience of the particular surgeon and his or her support staff that is the critical imperative when it comes to outcomes after radical prostatectomy as opposed to whether that surgeon chooses to use an open or a robot-assisted or other laparoscopic technique.

One Response

  1. No discussion of blood loss during the procedures? My understanding is that there is a significant difference. What I do not know is whether this is significantly worth stating. In other words, ORP may have more bleeding, but not enough to cause harm is likely. Another worthwhile discussion is the post-procedure hospitalization and follow up care. RALP physicians boast less time in the hospital, less blood loss. Lastly, open to discussion is financial. The study is silent here as well. In any case, the skillset is the most important factor in determining outcome in regards to recovery and results. This study does merely confirm what we already knew. Get a good surgeon if RP is your choice.

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