Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy

Objective: To compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period. Patients and Methods: The clinical and pathological data obtained in 50 consecutive patients who underwent retropubic radical prostatectomy (RRP) from January 2001 to December 2001 were compared to those obtained in 71 consecutive patients who were treated in the same year by extraperitoneal laparoscopic radical prostatectomy (LRP). The two groups were comparable in terms of mean pre-operative PSA and biopsy Gleason score. The peri-operative data included operative time, intra-operative and post-operative transfusion rates, complication rates, hospitalization length, and duration of catheterization. The following pathological parameters were considered: Gleason score, pathological stage, and positive surgical margin rate. A comparative evaluation of continence recovery (no pads and any leakage) was made only in patients with follow-up longer than 12 months. Results: The two groups were comparable in terms of pathological stage and definitive Gleason score. Operating times were significantly shorter in RRP (p < 0.0001). LRP patients showed higher autologous (p < 0.001) and eterologous transfusion (p = 0.03). No significant difference was observed in terms of complication rates (p = 0.07). The rectal injury rate was 2.8% in the laparoscopic group. The mean post-operative hospital stay was 10.2 +/- 2 days in the surgery group and 7.2 +/- 3.4 days in the laparoscopy group (p < 0.001). Catheterization time was 8.4 +/- 0.9 days in the surgery group and 8 +/- 2.8 days in the laparoscopy group (p = 0.27). After 12 months, complete continence was achieved in 64% of RRP and 40% of LRP patients, respectively (p = 0.29). Conclusion: The results of our non-randomized study show that up to now laparoscopic radical prostatectomy does not provide significant advantages in terms of peri-operative morbidity compared with the traditional retropubic approach. (C) 2003 Elsevier B.V. All rights reserved.