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Robotic prostate cancer surgery has curative advantage over traditional surgery

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Robotic-assisted surgery has increased significantly in recent years; however, controversy exists regarding its advantages over either traditional surgery or laparoscopic surgery. A new UCLA study has reported that robotic-assisted prostate cancer surgery results in a more complete eradication of malignant cells. The findings were published online on February 19 ahead of press in the journal European Urology.

In the comparison of robotic-assisted prostate cancer surgery to open surgery found that patients who had robotic surgery had fewer occurrences of cancer cells at the margin of the surgical specimen and less need of additional cancer treatments, such as hormone therapy or radiation, than patients who had open surgery. The study authors noted that robotic-assisted surgery is steadily increasing in popularity; however, robotic-assisted radical prostatectomy (RARP; the complete removal of the prostate robotically) has remained controversial because there was little evidence of better cancer control over open radical prostatectomy (ORP), which is the less costly traditional approach

To determine whether or not robotic surgery offered an advantage, the investigators conducted a retrospective study, which compared 5,556 patients who underwent RARP to 7,878 who underwent ORP from 2004 through 2009. The researchers accessed data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare, program of cancer registries, which collects clinical and demographic information regarding cancer patients. They compared the two groups by surgical margin status, which is the amount of cancer cells at the edge of the tumor specimen. A positive margin may result from cutting through the cancer and leaving some cancer behind, rather than completely cutting around the cancer. A positive margin for prostate cancer has been reported to lead to a greater risk of recurrence and death from the disease. The investigators also assessed the use of additional cancer therapy (androgen (male hormone) deprivation, or hormone therapy, and radiation) after robotic versus open surgery.

The researchers found that RARP was associated with 5% fewer positive surgical margins (those that tested positive for the presence of cancer): 13.6% versus 18.3 percent for ORP. This difference was greater for patients with intermediate- and high-risk prostate cancer. Compared to patients who underwent robotic surgery, patients who underwent robotic surgery also had a one-third reduction in likelihood of requiring additional cancer therapy within 24 months after the surgery.

The study findings indicate that despite a greater upfront cost for robotic surgery, the fewer positive surgical margins and less need for radiation therapy after robotic surgery may translate into less downstream costs as well as less side-effects from radiation and/or hormone therapy.

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