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| Randomized controlled trial comparing open anterograde anatomic radical retropubic prostatectomy with retrograde technique |
Fabricio B. Carrerette*( ),Daniela B. Rodeiro,Rui T. F. Filho,Paulo A. Santos,Celso C. Lara,Ronaldo Damião
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| Department of Surgery (Urology), Pedro Ernesto University Hospital of State University of Rio de Janeiro, Rio de Janeiro, Brazil |
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Abstract Objective: Radical prostatectomy is the recommended treatment for localized prostate cancer; however, it is an invasive procedure that can leave serious morbidity. Robot-assisted radical prostatectomy was introduced with the aim of reducing postoperative morbidity and facilitating rapid recovery compared to the traditional Walsh's open radical retropubic prostatectomy. Therefore, a protocol was developed to perform an open prostatectomy comparable to that performed by robotics, but without involving novel instrumentation.
Methods: A total of 220 patients diagnosed with localized prostate cancer underwent radical prostatectomy. They were divided into two groups: anterograde technique (115 patients) and the retrograde method (105 patients). The study outcomes were observed 3 months after surgery.
Results: No differences were found in terms of surgical time, hospital stay, and suction drainage. However, reduced bleeding was observed in the anterograde technique (p=0.0003), with rapid anastomosis duration (p=0.005). Among the patients, 60.9% undergoing the anterograde technique were continent 3 months after surgery compared to 42.9% treated by the retrograde method (p=0.007). Additionally, fewer complications in terms of the number (p=0.007) and severity (p=0.0006) were observed in the anterograde technique.
Conclusion: The anterograde method displayed increased efficiency in reducing complications, compared to the retrograde technique.
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Received: 28 January 2021
Available online: 20 April 2023
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Corresponding Authors:
Fabricio B. Carrerette
E-mail: carrerette2@gmail.com
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Consort flow diagram. AORP, open anterograde anatomic radical retropubic prostatectomy; ORP, open retrograde radical retropubic prostatectomy.
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| Characteristic | ORP (n=105) | AORP (n=115) | p-Value | | Age, median (IQR), year | 64 (60-68) | 64 (59-68) | 0.90a | | PSA, median (IQR), ng/mL | 8.43 (6.33-11.90) | 8.70 (5.92-12.30) | 0.57a | | Prostate, median (IQR), cm3 | 41 (32-54) | 40 (31-48) | 0.29a | | Biopsy Gleason score, n (%) | | | 0.48b | | 6 | 43 (41.0) | 38 (33.0) | | | 7 | 53 (50.5) | 66 (57.4) | | 8 or 9 | 9 (8.6) | 11 (9.6) | | | D'Amico, n (%) | | | 0.44b | | Low | 20 (19.0) | 19 (16.5) | | | Intermediate | 73 (69.5) | 76 (66.1) | | High | 12 (11.4) | 20 (17.4) | |
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Preoperative characteristics of cases in ORP group and AORP group.
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| Characteristic | ORP (n=105) | AORP (n=115) | p-Value | | Operative time median (IQR), min | 150 (120-180) | 140 (120-150) | 0.14a | | Anastomosis time, median (IQR), min | 25 (20-30) | 20 (15-30) | 0.005a | | Estimated blood loss, median (IQR), mL | 500 (300-600) | 300 (200-500) | 0.0003a | | Hospitalization, median (IQR), day | 3 (3-4) | 3 (3-4) | 0.16a | | Days with drain, median (IQR) | 3 (2-4) | 3 (2-4) | 0.09a | | Days with indwelling bladder catheter, median (IQR) | 14 (14-15) | 7 (7-7) | <0.0001a | | Nerve sparing, n (%) | | | 0.0009b | | Absent | 34 (32.4) | 14 (12.2) | | | Unilateral | 46 (43.8) | 59 (51.3) | | Bilateral | 25 (23.8) | 42 (36.5) | | | Surgical complication, n (%) | | | 0.007b | | Absent | 76 (72.4) | 100 (87.0) | | | Present | 29 (27.6) | 15 (13.0) | | | Clavien-Dindo classification, n (%) | | | 0.0006b | | Grade I | 2 (1.9) | 7 (6.1) | | | Grade II | 18 (17.1) | 3 (2.6) | | Grade III | 9 (8.6) | 5 (4.3) | | | Gleason score, n (%) | | | 0.11b | | 6 | 15 (14.3) | 22 (19.1) | | | 7 | 79 (75.2) | 72 (62.6) | | 8 or 9 | 11 (10.5) | 21 (18.3) | | | Pathologic stage, n (%) | | | 0.22b | | pT2a | 4 (3.8) | 11 (9.6) | | | pT2b | 12 (11.4) | 17 (14.8) | | pT2c | 68 (64.8) | 60 (52.2) | | pT3a | 7 (6.7) | 13 (11.3) | | pT3b | 14 (13.3) | 14 (12.2) | | | Lymph node, n (%) | | | 0.28b | | Negative | 65 (98.5) | 82 (95.3) | | | Positive | 1 (1.5) | 4 (4.7) | | | Surgical margin, n (%) | | | | | T2 negative | 64 (76.2) | 66 (75.0) | 0.85b | | T2 positive | 20 (23.8) | 22 (25.0) | | T3 negative | 12 (57.1) | 19 (70.4) | 0.34b | | T3 positive | 9 (42.9) | 8 (29.6) | | | Biochemical recurrence, n (%) | | | 0.69b | | Negative | 94 (89.5) | 101 (87.8) | | | Positive | 11 (10.5) | 14 (12.2) | | | Continence, n (%) | | | 0.007b | | Absent | 60 (57.1) | 45 (39.1) | | | Present | 45 (42.9) | 70 (60.9) | | | Sexual potency, n (%) | | | 0.34b | | Absent | 94 (89.5) | 98 (85.2) | | | Present | 11 (10.5) | 17 (14.8) | |
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Perioperative and postoperative outcomes and complications, oncological and functional control in ORP group and AORP group.
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