BERKELEY, CA (UroToday.com) - Radical prostatectomy has evolved in many ways in recent years, and this evolution has created a source of controversy on various levels.
While some dispute its legacy versus radiotherapy, others question its ability in preserving continence and erectile function and underscore the ultimate overtreatment of prostate cancer, while a third group fiercely defend open, and some the robotic approach, in performing the operation itself.
One of the real controversies in the past years however is the later dispute. Is robotic assisted prostatectomy (RALP) equal, superior or even possibly inferior to the open approach (ORRP)?
One of the arguments in favor of the robotic approach, but even more as an outcome parameter in general has been the issue of blood loss.
In this study, we evaluated the impact of intraoperative bleeding during ORRP on pathological and quality of life outcomes, incidence of anastomotic strictures, and surgical and medical complications among 1,511 prostate cancer patients who underwent the surgical procedure performed by a single surgeon. There was no relationship between intraoperative blood loss and any of the above outcome measures demonstrating that the greatest degree of intraoperative bleeding has no adverse impact on important oncological and quality of life outcomes. When analyzing the data using the 3 groups, based on tertiles of estimated blood loss (ml) as the reference parameter, we did not observe any association between the volume of estimated blood loss and the oncological and quality of life outcomes.
It is widely recognized that many claims have been made regarding the advantages of RALP compared to ORRP. The fact is indisputable that RALP is associated with less intraoperative bleeding. Our study is a single-surgeon experience and we would like to mention it as a limitation. In spite of this, our study provides further evidence that less bleeding cannot be extrapolated to imply better visualization resulting in better quality of life and oncological outcomes. While RALP has benefits and merits, they should not be explained or based on the blood loss related issues.
Written by:
Bob Djavan, MD, PhD* as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
*Professor of Urology, New York University