Functional and Oncologic Outcomes Between Open and Robotic Radical Prostatectomy at 24-month Follow-up in the Swedish LAPPRO Trial

Background: The adoption of robot-assisted laparoscopic radical prostatectomy (RALP) has increased rapidly, despite lack of conclusive evidence of its superiority regarding long-term outcomes over open retropubic RP (RRP). In 2015, we reported on 12-mo follow-up from the LAPPRO trial showing a moderate advantage of RALP regarding erectile dysfunction. No significant differences were seen for urinary incontinence or surgical margin status. Objective: To present patient-reported functional outcomes and recurrent and residual disease at 24-mo follow-up from the prospective multicenter LAPPRO trial. Design, setting, and participants: A total of 4003 patients with clinically localized prostate cancer were recruited from 14 Swedish centers, seven performing RALP and seven RRP. Outcome measurements and statistical analysis: Data were only analyzed for patients operated on by surgeons with >100 prior RPs. Adjusted odds ratios (AORs) were calculated using logistic regression, with adjustment for differences in patient mix. Results and limitations: At 24 mo, there was a significant difference in erectile dysfunction in favor of RALP (68% vs 74%; AOR 0.72, 95% confidence interval [CI] 0.57–0.91; p = 0.006). No significant difference was observed for incontinence (19% vs 16%; AOR 1.29, 95% CI 1.00–1.67; p = 0.053) or recurrent or residual disease (13% vs 13%; AOR 0.79, 95% CI 0.59–1.07; p = 0.13). We did not adjust for individual surgeon volume and experience, which is a potential limitation. Conclusions: Extended follow-up corroborated our previous report at 12 mo of a persistent RALP benefit regarding potency. Patient summary: LAPPRO is a Swedish trial comparing two different prostate cancer surgical techniques (robotic compared to open). At 24-mo follow-up after surgery there was a moderate advantage for the robotic technique regarding erectile dysfunction (potency), while there was a small but not significant difference in urinary leakage in favor of open surgery. We did not find any difference regarding cancer relapse. At 24-mo follow-up a moderate difference in favor of robot-assisted laparoscopic radical prostatectomy (RP) over open retropubic RP was observed for erectile dysfunction, and a small, but not statistically significant, difference in urinary incontinence was observed in favor of open surgery. There was no difference regarding recurrent or residual disease.