Prostatectomy: Minimally invasive versus open radical procedures

Clinical question How does minimally invasive radical prostatectomy (MIRP) compare with open retropubic radical prostatectomy (RRP)?

Bottom line Men with prostate cancer undergoing MIRP compared with those undergoing open RRP are more likely to experience shorter length of stay, fewer postoperative respiratory complications and stricture formation, but an increased risk of urinary incontinence and erectile dysfunction. (Level of evidence = 2b–)

Synopsis In the United States, the use of robotic-assisted MIRP has increased from 1% to 40% of all radical prostatectomies performed from 2001 to 2006. These investigators analyzed data from an observational cohort study from 2003 through 2007 using Medicare-linked information from men with prostate cancer undergoing either MIRP (n = 1,938) or RRP (n = 6,899). Various analyses were performed to control for baseline differences including urinary incontinence, erectile dysfunction, age, race, household income, and additional comorbid medical conditions. Additional analyses also controlled for tumor grade, pathological disease staging, and surgeon volume. Men undergoing MIRP experienced shorter length of stay, less need for blood transfusion, and lower risk of postoperative respiratory complications and stricture formation. However, the men undergoing MIRP also experienced more genitourinary complications, including postoperative incontinence and erectile dysfunction. The need for additional cancer therapy was similar with either surgical approach, suggesting no difference in survival benefit.