Understanding the roles of randomized trials for robotic prostatectomy

The long-standing debate on the relative benefits of robotic surgery reached a milestone this July with the publication of early results from the first randomized trial comparing open versus robotic radical prostatectomy. In their study, “Robot-assisted Laparoscopic Prostatectomy Versus Open Radical Retropubic Prostatectomy: Early Outcomes from a Randomized Controlled Phase 3 Study”, Yaxley et al. randomized 326 men at their institution to receive either radical retropubic prostatectomy (RRP) or robot-assisted laparoscopic prostatectomy (RALP) (1). Men were compared based on functional outcomes including urinary and sexual function (as measured by validated survey instruments, EPIC and IIEF) and oncologic outcomes including positive margin status and imaging or biochemical recurrence (at 24 weeks—not reported in the current paper). There was no significant difference in urinary and quality of life outcomes at 12 weeks post-operatively. In terms of oncologic outcomes the authors found a non-significant trend towards more positive surgical margins in the robotic surgical group.