Robotic Versus Open Radical Prostatectomy, Differences in Prostate Cancer–specific Survival—12 Years of Follow-up in the LAParoscopic Prostatectomy Robot Open Trial

Abstract

BACKGROUND AND OBJECTIVE: Localized prostate cancer can be treated with either robot-assisted laparoscopic prostatectomy (RALP) or open retropubic radical prostatectomy (RRP). This study aimed to analyze all-cause and prostate cancer-specific mortality 12 yr after surgery. METHODS: The nonrandomized multicenter LAParoscopic Prostatectomy Robot Open (LAPPRO) trial enrolled patients from 2008 to 2011. The eligibility criteria included age <75 yr, prostate-specific antigen <20 ng/ml, clinical stage <T4, nonmetastatic disease, and informed consent. Data were collected through validated questionnaires at baseline and clinical record forms repeatedly up to 12 yr after surgery, with mortality information retrieved from Sweden's National Cause of Death Register. The main outcomes were all-cause and prostate cancer-specific mortality. KEY FINDINGS AND LIMITATIONS: Of the 4003 patients enrolled in LAPPRO, 3583 were eligible for the current analysis, of whom 2698 (75%) underwent RALP and 885 (25%) RRP. At 12 yr after surgery, prostate cancer-specific mortality was significantly lower after RALP than after RRP (55/2698 [2.0%] vs 40/885 [4.5%]; adjusted hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23-0.55). The numbers of all-cause deaths were 371/2698 (14%) in the RALP group and 145/885 (16%) in the RRP group (adjusted HR 0.81, 95% CI 0.66-0.99). The study is limited by its nonrandomized design. CONCLUSIONS AND CLINICAL IMPLICATIONS: At 12 yr after surgery, prostate cancer-specific mortality was significantly lower in patients undergoing robotic prostatectomy than in those undergoing open prostatectomy. Cautious interpretation is suggested for the possible causal effect, but the results suggest that the robotic technique is associated with a better oncological outcome.