Análisis crítico comparativo de prostatectomía radical abierta, laparoscópica y robótica: resultados de morbilidad perioperatoria y control oncológico (Parte I)

Abstract

OBJECTIVES: With regard to oncological outcomes and perioperative morbidity, surgical treatment of localized prostate cancer has proved to be an excellent treatment option. At present, there are three different approaches, open, laparoscopic and robotic. Open radical prostatectomy remains the "gold Standard" due to accumulated experience and long follow up of series. But, without a doubt, laparoscopic and robotic groups are contributing with a far from negligible experience. Looking carefully at outcomes we will have to elucidate amongst advantages and disadvantages of each one of them. In this study we have performed a review of the literature trying to compare the three techniques, focusing in available surgical morbidity and oncological outcomes. METHODS: We performed a systematic search in the following data bases: PubMed; EMBASE; Cochrane; SCOPUS; Science Citation Index, from January 1990 to January 2007 for terms: "radical retropubic prostatectomy"; "open radical prostatectomy"; "laparoscopic prostatectomy"; "laparoscopic radical prostatectomy"; "robotic prostatectomy"; "robotic radical prostatectomy"; "treatment outcome", "oncologic outcome"; "outcomes morbidity"; "mortality" and "minimally invasive treatment". We analyzed the most representative series (finished learning curve) in each one of the three approaches regarding perioperative morbidity and oncological outcomes. RESULTS: To be able to perform an objective and truthful comparison of the three techniques, there is an absence in randomized studies in the literature. In this scenario we have analyzed the most representative individual series. With respect to the analyzed perioperative results, it seems to be no clear differences regarding surgical time, intraoperative complications, and catheter and hospital stay days. Otherwise, the endoscopic approach (laparoscopy and robotics) show a more favorable results in respect of blood loss and less postoperatorive analgesic. The short-term oncological outcomes (surgical margins) seem to be comparable amongst the three approaches. We only have long-term data (more than 10 years) on open series biochemical recurrence. CONCLUSIONS: The open surgery has become a reference for all comparisons. The laparoscopic surgery is being replaced (specially in North America) by robotic surgery which is constantly expanding. It is necessary the publication of randomized and prospective studies to be able to objectively compare the three techniques.