Perioperative, functional and oncological outcomes after open and minimally invasive prostate cancer surgery: experience from Australasia

OBJECTIVE To systematically review the current literature concerning perioperative, functional and oncological outcomes reported after open and minimally invasive prostate cancer surgery specifically from institutions within Australasia. MATERIALS AND METHODS Four electronic databases were searched to identify studies reporting outcome after open and minimally invasive prostate cancer surgery. Studies were sought using the search term 'radical prostatectomy'. In all, 11 378 articles were retrieved. For the purpose of this review, data were only extracted from studies reporting Australasian experience. A total of 28 studies met final inclusion criteria. RESULTS Overall, the data are limited by the low methodological quality of available studies. Only two comparative studies evaluating open radical prostatectomy (ORP) and robotic-assisted laparoscopic RP (RALP) were identified, both non-randomized. The mean blood loss, catheterization time and hospital stay was shorter after RALP than with ORP. In contrast, mean operative procedure time was significantly longer for RALP. Overall adverse event rates were similar for the different surgical approaches although the rate of bladder neck stricture was significantly higher after open RP. Incorporation of patient outcomes achieved by surgeons still within their learning curve resulted in a trend towards higher positive surgical margin rates and lower continence scores after RALP. However, there was equivalence once the surgeons' learning curve was overcome. Given the limited follow-up for RALP and laparoscopic RP (14.7 and 6 months vs 43.8 months for ORP) and the lack of data concerning erectile function status, comparison of biochemical failure and potency was not possible. CONCLUSIONS Few comparative data are available from Australasia concerning open and minimally invasive prostate cancer surgery. While perioperative outcomes appear to favour minimally invasive approaches, further comparative assessment of functional and long-term oncological efficacy for the different surgical approaches is required to better define the role of minimally invasive approaches.