RALP vs Open

John T

Veteran Member

Joined : Nov 2008

Posts : 4315

Posted 1/31/2012 5:32 PM (GMT 0)

There have been a few recent posts about RALP vs open. The New Prostate Cancer Info Link just posted this study comparing open with Robotic:

Here are the survey results:

685/797 eligible patients (85.9 percent) returned completed surveys.
Of these 685 eligible patients
- 406 men (59.3 percent) reported having had a RALP.
- 220 men (32.1 percent) reported having had open surgery.
189/607 men (31.1 percent) reported having a moderate or big problem with continence.
522/593 men (88.0 percent) reported having a moderate or big problem with sexual function.
Model-based analyses, with appropriate adjustments for patient age and educational level, predicted that
- RALP was actually associated with a non-significant trend toward greater problems with continence (odds ratio [OR] = 1.41).
- RALP was not associated with greater problems with sexual function (OR = 0.87).

In other words, even though RALP is now much more common than open radical prostatectomy as a surgical treatment for men with clinically localized prostate cancer, there are in fact no data to suggest that post-surgical continence or sexual function are any better after RALP than they are after open surgery.

Now, carefully selected surgeons may indeed be able to demonstrate that their personal outcomes (in terms of continence and sexual function) are in fact “better than the average” using either open surgical procedures or RALP. As The “New” Prostate Cancer InfoLink regularly observes, the skill levels of individual surgeons are much more likely to be a key factor in such outcomes than the technology used to carry out the surgery. Some physicians may be able to achieve such results through the use of robot-assisted techniques; others may prefer to use open surgery. What one can not expect, however, is that having one’s surgery carried out with robot assistance necessarily improves the probability of high continence and good sexual function post-surgery

Tony Crispino

Veteran Member

Joined : Dec 2006

Posts : 8160

Posted 1/31/2012 5:43 PM (GMT 0)

Interestingly the study left out one very important piece ~ physician experience.

The docs who have recently trended to RALP do not have the same experience as those who opted over many years ago. We all know that physician experience matters and RALP has not been around as long as the open procedure. My experience with robotic was as advertised by a physician who had over a thousand to his name and was a leading pioneer using the DaVinci system.

Also left off the discussion is which DaVinci? There are very few Version 1 and 2 out there in the US but Version 3's are still in use. Today the latest is version 5. This system uses the best available lenses, displays, software and control mechanisms. These are some of the questions that patients looking at the procedure should ask.

What version DaVinci system will you be using? (Version 5 is the latest, but Version 4 is likely the device the surgeon is most familiar with)
How long have you used that system? (look for over five years)
How many robotic procedures have you done? (look for hundreds to over a thousand)

I know the "assembly line" surgeon's have received some static here but that's a mistake. These docs are the most versed at using this equipment and likely will have the best results exceeding those reported in the small cohort above.

Tony

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