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Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study
Author(s) -
Fracalanza Simonetta,
Ficarra Vincenzo,
Cavalleri Stefano,
Galfano Antonio,
Novara Giacomo,
Mangano Angelo,
Plebani Mario,
Artibani Walter
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2008.07513.x
Subject(s) - medicine , urology , laparoscopic radical prostatectomy , interquartile range , prostatectomy , mann–whitney u test , radical retropubic prostatectomy , prospective cohort study , laparoscopy , continuous variable , surgery , prostate cancer , cancer
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‐1α, 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‐1α did not change at the different sample times. CONCLUSIONS This study showed for the first time that RALP induces lower tissue trauma than RRP.