Our Summary

This research paper is about the use of robot-assisted surgery for prostate cancer in France. Though the number of surgeries for prostate cancer is decreasing, the use of robot-assisted surgeries is rising. The study aims to determine whether using a robot for this surgery is beneficial enough to warrant funding from health authorities.

To achieve this, the researchers looked at previous studies that compared robot-assisted surgery, laparoscopic surgery (a less invasive surgery using a camera), and open surgery. They found only two studies that directly compared robot-assisted and laparoscopic surgeries.

The results showed that patients who had robot-assisted surgery had better sexual function after their operations compared to those who had laparoscopic surgery. When compared to open surgery, the sexual function was also better for those who had robot-assisted surgery. The chances of erectile dysfunction were also lower.

In terms of urine control (continence), robot-assisted surgery was better than laparoscopic surgery 3 months after the operation. When compared to open surgery, the results were mixed. Sometimes robot-assisted surgery was better, sometimes it was the same.

The success rate of the surgery in terms of removing the cancer (the rate of positive margins) was the same, regardless of the type of surgery. There was also no significant difference in the complications during the surgery between robot-assisted, laparoscopic, and open surgery.

In conclusion, robot-assisted surgery for prostate cancer has the same success rate in removing the cancer as laparoscopic and open surgery. However, it has better outcomes in terms of sexual function and urine control. But, there is no study that directly compares robot-assisted surgery and open surgery.

FAQs

  1. What is the difference between robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP)?
  2. Are there any significant differences in terms of perioperative complications between RARP, LRP and OP?
  3. Are the long-term oncological outcomes the same for all three methods of prostatectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about prostatectomy is to discuss the potential benefits and risks of robotic prostatectomy compared to other surgical approaches, such as laparoscopic or open surgery. It is important for the patient to understand that robotic prostatectomy may offer better outcomes in terms of continence and sexual function, but that long-term oncological outcomes are similar across all surgical techniques. Ultimately, the choice of surgical approach should be based on individual factors and preferences, and a thorough discussion with the healthcare provider.

Suitable For

Patients who are typically recommended for prostatectomy are those with localized prostate cancer who have a life expectancy of at least 10 years and are in good overall health. Patients who are younger, have a longer life expectancy, and have a higher risk of cancer progression may be good candidates for robotic prostatectomy. Additionally, patients who are concerned about post-operative continence and sexual function may also benefit from robotic prostatectomy, as studies have shown improved outcomes in these areas compared to traditional open or laparoscopic surgery.

Timeline

  • Before prostatectomy: The patient will typically undergo various tests and evaluations to determine the best course of treatment for their prostate cancer. This may include a biopsy, imaging tests, and consultations with urologists and oncologists. The patient will also receive counseling on the potential side effects of surgery, such as erectile dysfunction and urinary incontinence.

  • After prostatectomy: The patient will undergo the surgery, which can be done through open surgery, laparoscopic surgery, or robot-assisted surgery. After the procedure, the patient will need to stay in the hospital for a few days for monitoring and recovery. They will then need to follow up with their healthcare team for post-operative care and monitoring. The patient may experience side effects such as urinary incontinence and erectile dysfunction, which can improve over time with rehabilitation and support. Long-term follow-up will be necessary to monitor for any signs of cancer recurrence.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with robotic prostatectomy compared to other surgical approaches?
  2. How does the recovery process differ between robotic, laparoscopic, and open prostatectomy?
  3. What are the long-term oncological outcomes following robotic prostatectomy compared to other surgical techniques?
  4. How soon after surgery can I expect to regain continence and sexual function?
  5. Are there any specific factors that may make me a better candidate for robotic prostatectomy over other surgical options?
  6. How experienced is the surgical team in performing robotic prostatectomies, and what is their success rate?
  7. What should I expect in terms of post-operative follow-up care and monitoring?
  8. Are there any lifestyle changes or precautions I should take following robotic prostatectomy to optimize my recovery and outcomes?
  9. How soon after surgery can I resume normal activities, such as exercise and work?
  10. Are there any additional resources or support groups available for patients undergoing robotic prostatectomy?

Reference

Authors: Long JA, Poinas G, Fiard G, Leprêtre M, Delaitre-Bonnin C, Rébillard X, Descotes JL. Journal: Prog Urol. 2017 Mar;27(3):146-157. doi: 10.1016/j.purol.2016.12.010. Epub 2017 Feb 4. PMID: 28169123