Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study.

Abstract

OBJECTIVES:

To evaluate whether robotically assisted laparoscopic prostatectomy (RALP) is less invasive than radical retropubic prostatectomy (RRP), as experimental studies suggest that the acute phase reaction is proportional to surgery-induced tissue damage.

PATIENTS AND METHODS:

Between May and November 2006, all patients undergoing RRP or RALP in our department were prospectively assessed. Blood samples were collected 24 h before (T0), during surgery (T1), at the end of anaesthesia (T2), and 12 (T3) and 24 h after surgery (T4), and assayed for interleukin(IL)-6 and IL-1 alpha, C-reactive protein (CRP), and lactate. The Mann-Whitney U-, Student's t- and Friedman tests were used to compare continuous variables, and the Pearson chi-square and Fisher test for categorical variables, with a two-sided P < 0.05 considered to indicate significance.

RESULTS:

In all, 35 and 26 patients were assessed for RALP and RRP, respectively; the median (interquartile range) age was 62 (56-68) and 68.5 (59.2-71.2) years, respectively (P < 0.009). Baseline levels (T0) of IL-1, IL-6, CRP and lactate were comparable in both arms. IL-6, CRP and lactates levels increased during both kinds of surgery. The mean IL-6 and CPR values were higher for RRP at T1 (P = 0.01 and 0.001), T2 (P = 0.001 and <0.001), T3 (P = 0.002 and <0.001) and T4 (P < 0.001 and 0.02), respectively. Lactate was higher for RRP at T2 (P = 0.001), T3 (P = 0.001) and T4 (P = 0.004), although remaining within the normal ranges. IL-1 alpha did not change at the different sample times.

CONCLUSIONS:

This study showed for the first time that RALP induces lower tissue trauma than RRP.

• Authors: Simonetta Fracalanza, Vincenzo Ficarra, Stefano Cavalleri, Antonio Galfano, Giacomo Novara, Angelo Mangano, Mario Plebani, Walter Artibani
• Journal: BJU international (BJU Int) Vol. 101 Issue 9 Pg. 1145-9 (May 2008) ISSN: 1464-410X [Electronic] England
• PMID: 18399830 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Interleukin-1alpha
• Interleukin-6
• Lactic Acid
• C-Reactive Protein

Topics

• Acute-Phase Reaction (prevention & control)
• Aged
• C-Reactive Protein (analysis)
• Humans
• Interleukin-1alpha (blood)
• Interleukin-6 (blood)
• Lactic Acid (blood)
• Laparoscopy
• Male
• Middle Aged
• Postoperative Complications (prevention & control)
• Prospective Studies
• Prostatectomy (adverse effects, methods)
• Prostatic Neoplasms (blood, surgery)
• Robotics
• Statistics, Nonparametric
• Treatment Outcome