Jeong Chang Wook, Yoo Sang Hyun, Han Jang Hee, Jeong Seung-Hwan, Yuk Hyeong Dong, Ku Ja Hyeon, Kim Hyeon Hoe, Kwak Cheol
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Myongji Hospital, Goyang, Korea.
World J Mens Health. 2025 May 15. doi: 10.5534/wjmh.240090.
Radical prostatectomy remains the primary treatment for localized prostate cancer (PCa). Despite its use for over two decades, the benefits of robot-assisted radical prostatectomy (RARP) remain unclear. We evaluated the surgical, functional, and oncological outcomes between RARP and open radical retropubic prostatectomy (RRP).
This prospective cohort study included men who underwent radical prostatectomy between March 2016 and April 2020. We excluded patients who received preoperative androgen-deprivation therapy, had an initial prostate-specific antigen level of >50 ng/mL, had a clinical T stage of ≥T3b, and those aged under 50 or over 80 years. The primary outcome was the 90-day complication rate. Surgical and oncologic outcomes were compared. Continence and potency recovery were depicted using Kaplan-Meier curves and assessed using the log-rank test. To balance baseline characteristics, stabilized inverse probability of treatment weighting (sIPTW) was used.
Among the 1,306 patients assessed, 1,055 were included after exclusion and adjustment using the sIPTW (RARP, n=835; RRP, n=220), with a median follow-up of 39 months. The RARP group had a significantly lower 90-day complication rate than the RRP group (8.9% 26.4%; p<0.001). The RARP group showed significantly better surgical outcomes, including estimated blood loss and surgical margins. At 36 months, the pad-free rates were 86.1% and 88.4% for the RARP and RRP groups, respectively (log-rank test, p=0.642). Potency recovery was superior in the RARP group (11.4% 5.2%; log-rank test, p=0.001). Biochemical recurrence (RARP, 23.7%; RRP, 27.9%; p=0.246) and rates of additional treatment (RARP, 23.5%; RRP, 28.1%; p=0.202) were not different. Single-institution study is a potential limitation.
The findings indicate that RARP is associated with a better safety profile and surgical outcomes without compromising short-term oncologic outcomes than RRP. While continence recovery was comparable between the methods, RARP may offer superior potency recovery.
根治性前列腺切除术仍是局限性前列腺癌（PCa）的主要治疗方法。尽管其已应用二十多年，但机器人辅助根治性前列腺切除术（RARP）的益处仍不明确。我们评估了RARP与开放性耻骨后根治性前列腺切除术（RRP）在手术、功能和肿瘤学方面的结果。
这项前瞻性队列研究纳入了2016年3月至2020年4月期间接受根治性前列腺切除术的男性。我们排除了接受术前雄激素剥夺治疗、初始前列腺特异性抗原水平>50 ng/mL、临床T分期≥T3b以及年龄在50岁以下或80岁以上的患者。主要结局是90天并发症发生率。比较手术和肿瘤学结果。使用Kaplan-Meier曲线描述控尿和性功能恢复情况，并使用对数秩检验进行评估。为平衡基线特征，采用稳定的治疗权重逆概率（sIPTW）。
在评估的1306例患者中，使用sIPTW进行排除和调整后纳入1055例（RARP组，n = 835；RRP组，n = 220），中位随访时间为39个月。RARP组的90天并发症发生率显著低于RRP组（8.9%对26.4%；p<0.001）。RARP组的手术结果明显更好，包括估计失血量和手术切缘。在36个月时，RARP组和RRP组的无垫率分别为86.1%和88.4%（对数秩检验，p = 0.642）。RARP组的性功能恢复情况更好（11.4%对5.2%；对数秩检验，p = 0.001）。生化复发率（RARP组为23.7%；RRP组为27.9%；p = 0.246）和额外治疗率（RARP组为23.5%；RRP组为28.1%；p = 0.202）没有差异。单机构研究是一个潜在的局限性。
研究结果表明，与RRP相比，RARP具有更好的安全性和手术结果，且不影响短期肿瘤学结果。虽然两种方法的控尿恢复情况相当，但RARP可能在性功能恢复方面更具优势。
