South African single surgeon experience: Comparison of oncological outcomes, robot-assisted radical prostatectomy versus open perineal radical prostatectomy

Background: Studies comparing oncological outcomes between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) are often limited by bias because of their multi-institutional and multiple surgeon design. Studies from a single institution and single surgeon are uncommon. Objective: To compare oncological outcomes between RARP and ORP at a single institution by a single surgeon. Design, setting and participants: A retrospective cohort study of 2376 men with localized prostate cancer who underwent either RARP or ORP, from 1995 to 2020 at single institution, by one surgeon was done. The first 100 cases were discounted in both cohorts to account for the learning curve. Measurements: Positive surgical margin (PSM) and biochemical recurrence (BCR) rates were measured for each cohort. Results: A total of 1566 men underwent ORP and 810 underwent RARP. BCR rates of 29.2% were found in the ORP group versus 19.5% in the RARP group (p < 0.001). PSM rates of 15.4% were found in the ORP group versus 9.0% in the RARP group (p < 0.001). A multivariate analysis of preoperative prostate specific antigen (PSA) and tumor stage (T) shows no statistically significant association with recurrence when controlled for surgical technique. Conclusions: RARP produces better oncological outcomes when compared to ORP when performed by one experienced surgeon at a single institution. Patient summary: In this large study of men with prostate cancer still localized to the prostate. We found that better cancer removal and chances of cancer recurrence are reduced by a robot-assisted prostate removal technique, compared to the traditional open technique.