Comparison of outcomes between pure laparoscopic vs robot‐assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Few studies exist comparing functional outcomes between RALP and LRP using validated questionnaires. This single surgeon study utilizes data from the EPIC questionnaire that was collected prospectively to compare urinary and sexual function after prostatectomy. In this comparison, return of post‐prostatectomy continence was similar between groups while RALP patients demonstrated earlier return of sexual function. OBJECTIVE To compare perioperative, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) and robot‐assisted laparoscopic radical prostatectomy (RALP) with emphasis on health‐related quality of life (HRQOL) data as few studies exist. PATIENTS AND METHODS Patients underwent RALP or LRP by a single, fellowship trained surgeon with a standard clinical care pathway. HRQOL data using the Expanded Prostate Cancer Index Composite (EPIC) were collected at 0, 3, 6 and 12 months after 175 consecutive LRP and 174 RALP procedures. Urinary and sexual function outcomes were compared using two methods: (1) EPIC summary/subscale analyses described as percent return to baseline function and (2) traditional single‐question analysis. RESULTS The two groups were statistically similar with respect to demographics, clinical stage, perioperative outcomes, stage‐specific surgical margin rates, and baseline urinary and sexual function scores. There was no statistical difference in postoperative urinary function between RALP and LRP using EPIC or single‐question analyses at 3, 6 and 12 months. EPIC questionnaire data showed a greater return to baseline sexual function over time (mixed model analysis) in RALP than in LRP patients who had a bilateral nerve sparing procedure (Sexual Summary Score, P = 0.005; Sexual Function and Bother Subscales, P = 0.007). Using EPIC, RALP patients receiving a bilateral nerve sparing procedure showed improved percent return to baseline potency at 3 and 6 months ( P < 0.025) compared with LRP patients, but had similar outcomes at 12 months (73.7% vs 66.2%, P = 0.3). Single‐question analysis suggested improved potency after RALP compared with LRP, with a greater percentage of RALP patients reporting successful sexual intercourse in the past 4 weeks (87.5% vs 66.7% at 12 months, P = 0.06). CONCLUSIONS When comparing surgical techniques, RALP and LRP groups showed statistically similar postoperative urinary function outcomes. RALP patients had an earlier return of sexual function when compared with LRP patients after a bilateral nerve sparing procedure.