FREE PAPER Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches Received: 11 November 2002 / Accepted: 15 November 2002 / Published online: 3 April 2003 Ó Springer-Verlag 2003 Abstract We prospectively compared, within the same center and during the same period of time, the periop- erative parameters as well as the oncological and func- tional results of both open retropubic (ORP) and laparoscopic radical prostatectomy (LRP). From Sep- tember 1999 to September 2001, 162 patients with pros- tate cancer were treated with radical prostatectomy, 77 using an open retropubic technique, and 85 by the laparoscopic extraperitoneal approach. We prospectively recorded pre-, per- and postoperative parameters and complications, and evaluated the carcinological and functional results, comparing both approaches. There were no significant differences in the preoperative char- acteristics of the two groups. Mean operative time was statistically longer with LRP than with ORP (288 vs 168 min, P<0.0001) but median blood loss was decreased (400 vs 1,300 ml, P<0.0001). Major compli- cations occurred in a similar number of cases (5% vs 2.4%, NS) while minor complications occurred more frequently with ORP (24.6 vs 11.8%, P=0.003). Patho- logical examination revealed a similar distribution of Gleason scores and stages in each group. Positive surgi- cal margins in pT2 cases occurred in 7.8% of LRP and 7.3% of ORP. Continence rates (no pad and no leakage at all) were similar (83.9% in ORP vs 80.7% in LRP, NS). Potency rates were similar after 1 year in patients undergoing bilateral nerve sparing (55% in ORP vs 65% in LRP, NS). However, patients operated by LRP had more spontaneous erections. We conclude that this prospective, comparative study shows that LRP, when performed in specialized centers, gives oncological and functional results comparable to open surgery. Keywords Prostate cancer Æ Radical prostatectomy Æ Laparoscopy Æ Open surgery Radical prostatectomy has been a mainstay in the treatment of localized prostate cancer for more than two decades [22]. This oncological procedure should aim at achieving optimal cancer control with minimal morbid- ity and the best functional results. Along with a general trend towards minimally inva- sive surgery, laparoscopic radical prostatectomy (LRP) was first performed in 1992. It has been popular since 1998 and has gained a lot of attention in the urological community over the last years [8, 24]. Two approaches have been described for the lapa- roscopic procedure: transperitoneal and extra-peritoneal [3, 9, 12]. Various centers worldwide now regularly perform LRP and the early results show encouraging oncological and functional outcomes with low periop- erative morbidity and complications [10, 12, 32]. In light of these data, several authors already advocate laparo- scopic radical prostatectomy as a first-line surgical treatment for localized prostate cancer [9]. Nevertheless, beside a clear reduction in transfusion rate and bladder catheterization time, the questions of oncological con- trol and functional outcome have not been compared to the gold standard open procedure. Ideally, a randomized prospective study should be performed (by the same surgeon) in order to answer these questions. However, performing a randomized study is particularly difficult for several reasons; for in- stance expertise in both techniques by the same surgeon and acceptance by patients. We present a prospective comparison, within the same center during the same period of time, of the per- operative and postoperative parameters as well as the oncological and functional results of both open retrop- ubic (ORP) and LRP. We aim to give a better insight World J Urol (2003) 20: 360–366 DOI 10.1007/s00345-002-0306-z Thierry Roumeguere Æ Renaud Bollens Marc Vanden Bossche Æ Dan Rochet Æ David Bialek Paul Hoffman Æ Thierry Quackels Æ Amir Damoun Eric Wespes Æ Claude C. Schulman Æ Alexandre R. Zlotta T. Roumeguere (&) Æ R. Bollens Æ M. Vanden Bossche D. Rochet Æ D. Bialek Æ P. Hoffman Æ T. Quackels A. Damoun Æ E. Wespes Æ C.C. Schulman Æ A.R. Zlotta Department of Urology, Erasme Hospital - University Clinics of Brussels, 808 route de Lennik, 1070 Brussels, Belgium E-mail: thierry.roumeguere@ulb.ac.be Tel.: +32-2-5553614 Fax: +32-2-5553699