Radical retropubic robots.

Top Line: Robotic surgery for gyn cancer hasn’t lived up to the hype. Let’s refocus on the male persuasion.
The Study: This Australian phase 3 trial randomized over 300 men with localized prostate cancer and PSA < 20 to standard open radical retropubic prostatectomy versus a robotic approach. One primary outcome was urinary and sexual function per EPIC questionnaires at 6, 12 and 24 months, which were all remarkably almost identical between groups. The second primary outcome were biochemical recurrence (BR, defined as any post-op PSA ≥ 2) rates at the same time points, which were remarkably different, and not in the way you might think. BR within 24 months occurred in 13/151 (9%) undergoing the standard open resection and only 4/157 (3%) undergoing robotic resection. This really makes no sense, but the authors are quick to point out that [1] adjuvant and/or salvage treatments were in no way randomized across institutions and [2] men in the robotic arm were more likely to receive adjuvant radiation prior to documented BR. The other big caveat? A single surgeon performed all the robotic prostatectomies so...kudos to him or her.
Bottom Line: Robotic prostatectomies don’t appear to improve (or worsen) toxicity rates, but they may very well offer a less invasive way to achieve equally good oncologic outcomes. At least when performed by a certain Aussie surgeon. | Coughlin, Lancet Oncol 2018


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