Comparison of Open and Laparoscopic Radical Prostatectomy Outcomes from a Surgeon's Early Experience

Objectives: The comparative safety and efficacy of radical retropubic prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP) performed by a newly trained surgeon have not been well documented. Methods: Data were prospectively collected from the first 75 cases each of RRP and LRP performed contemporaneously after urologic training. Urologic complications, pathologic outcomes, and health-related quality-of-life outcomes were assessed, the latter by validated questionnaire at 0, 3, 6, 12, and 24 months. Results: A selection bias was evident, because the RRP patients had a greater prostate-specific antigen level, body mass index, and pathologic stage than did the LRP patients. Nevertheless, the positive margin rates were low overall (19% RRP and 9% LRP, P = 0.18) and for those with pT2 disease (4% RRP and 6% LRP). With a mean follow-up of just longer than 2 years, 19 (25%) of 75 RRP patients required 32 subsequent procedures and 8 (11%) of 75 LRP patients required 10 procedures (P = 0.02). The bladder neck contracture rate was 16% for RRP and 3% for LRP (P = 0.02), and artificial urinary sphincters were placed in 7 RRP and 0 LRP patients. At 12 months, 47% and 64% of the RRP and LRP patients were fully continent, respectively (P = 0.046), and the LRP cohort used fewer pads (P = 0.022). Of the preoperatively potent patients who underwent a nerve-sparing procedure, 44% of the RRP and 41% of the LRP group were potent at 12 months (P = 0.79). Conclusions: In one surgeon's initial experience, LRP resulted in fewer urologic complications and more reliable continence outcomes than did RRP without compromising potency or cancer control. Both procedures require experience to achieve acceptable health-related quality-of-life outcomes.