Robotic-assisted versus laparoscopic surgery

• Verfasst von: Stolzenburg, Jens-Uwe [VerfasserIn]
• Verfasst von: Holze, Sigrun [VerfasserIn]
• Verfasst von: Neuhaus, Petra [VerfasserIn]
• Verfasst von: Kyriazis, Iason [VerfasserIn]
• Verfasst von: Do, Hoang Minh [VerfasserIn]
• Verfasst von: Dietel, Anja [VerfasserIn]
• Verfasst von: Truss, Michael C. [VerfasserIn]
• Verfasst von: Grzella, Corinn I. [VerfasserIn]
• Verfasst von: Teber, Dogu [VerfasserIn]
• Verfasst von: Hohenfellner, Markus [VerfasserIn]
• Verfasst von: Rabenalt, Robert [VerfasserIn]
• Verfasst von: Albers, Peter [VerfasserIn]
• Verfasst von: Mende, Meinhard [VerfasserIn]
• Titel: Robotic-assisted versus laparoscopic surgery
• Titelzusatz: outcomes from the first multicentre, randomised, patient-blinded controlled trial in radical prostatectomy (LAP-01)
• Verf.angabe: Jens-Uwe Stolzenburg, Sigrun Holze, Petra Neuhaus, Iason Kyriazis, Hoang Minh Do, Anja Dietel, Michael C. Truss, Corinn I. Grzella, Dogu Teber, Markus Hohenfellner, Robert Rabenalt, Peter Albers, Meinhard Mende
• Jahr: 2021
• Umfang: 10 S.
• Fussnoten: Gesehen am 23.02.2022
• Titel Quelle: Enthalten in: European urology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1976
• Jahr Quelle: 2021
• Band/Heft Quelle: 79(2021), 6, Seite 750-759
• ISSN Quelle: 1873-7560
• ISSN Quelle: 1421-993X
• DOI: doi:10.1016/j.eururo.2021.01.030
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Continence
• Sach-SW: Laparoscopic prostatectomy
• Sach-SW: Multicentre randomised trial
• Sach-SW: Prostate cancer
• Sach-SW: Prostatectomy
• Sach-SW: Robotic-assisted prostatectomy
• K10plus-PPN: 1793750041

Abstract

Background - The LAP-01 trial was designed to address the lack of high-quality literature comparing robotic-assisted (RARP) and laparoscopic (LRP) radical prostatectomy. - Objective - To compare the functional and oncological outcomes between RARP and LRP at 3 mo of follow-up. - Design, setting, and participants - In this multicentre, randomised, patient-blinded controlled trial, patients referred for radical prostatectomy to four hospitals in Germany were randomly assigned (3:1) to undergo either RARP or LRP. - Outcome measurements and statistical analysis - The primary outcome was time to continence recovery at 3 mo based on the patient’s pad diary. Secondary outcomes included continence and potency as well as quality of life in addition to oncological outcomes for up to 3 yr of follow-up. Time to continence was analysed by log-rank test and depicted by the Kaplan-Meier method. Continuous measurements were analysed by means of linear mixed models. - Results and limitations - A total of 782 patients were randomised. The primary endpoint was evaluable in 718 patients (547 RARPs; full analysis set). At 3 mo, the difference in continence rates was 8.7% in favour of RARP (54% vs 46%, p =  0.027). RARP remained superior to LRP even after adjustment for the randomisation stratum nerve sparing and age >65 yr (hazard ratio = 1.40 [1.09-1.81], p =  0.008). A significant benefit in early potency recovery was also identified, while similar oncological and morbidity outcomes were documented. It is a limitation that the influence of different anastomotic techniques was not investigated in this study. - Conclusions - RARP resulted in significantly better continence recovery at 3 mo. - Patient summary - In this randomised trial, we looked at the outcomes following radical prostate surgery in a large German population. We conclude that patients undergoing robotic prostatectomy had better continence than those undergoing laparoscopic surgery when assessed at 3 mo following surgery. Age and the nerve-sparing technique further affected continence restoration.