Comparison of the perioperative outcome of robotic-assisted laparoscopic and laparoscopic radical prostatectomy after neoadjuvant hormonal therapy
Han Wencong1,△, Wu Yongji2,△, Sun Xudong3,△, Wang Yu3, Meng Yisen1, Zhang Cuijian1, Cai Lin1, Shen Cheng1, Zhang Zheng1,*, Li Xuesong1, Zhang Qian1, Zhang Kai1, Gong Kan1, He Zhisong1, Zhou Liquan1
1Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China; 2Department of Urology, Zhengzhou Ninth People’s Hospital, Zhengzhou 450000; 3Department of Urology, Peking University First Hospital, Xinxiang Central Hospital, Xinxiang 453000
Abstract：Objective： To compare the perioperative efficacy of laparoscopic radical prostatectomy （LRP） and robot-assisted laparoscopic radical prostatectomy （RARP） after neoadjuvant hormonal therapy, and to explore the influence of neoadjuvant hormonal therapy on the two surgical modes. Methods： A retrospective analysis was conductedfrom January 2019 to December 2021 on 128 patients undergoing radical prostatectomy after neoadjuvant hormonal therapy treated by the Center, of which 69 cases underwent laparoscopic surgery and 59 cases underwent robotic-assisted laparoscopic surgery. The patient’s clinical pathological data, including age, time of neoadjuvant hormonal therapy, prostate-specific antigen （PSA）, Gleason score, etc., were summarized. The Mann-Whitney U test was used to compare the operation time, postoperative drainage and postoperative hospital stay of the two surgical methods. The learning curve of robotic surgery was plottedby the CUSUM analysis method. Results： There were no significant differences in intraoperative bleeding, intraoperative blood transfusion and postoperative drainage between the two surgical modes （P>0.05）. The operation time and postoperative hospital stay of RARP were longer than those of LRP （P< 0.05）. After the number of RARP operations increased to the inflection point of the learning curve （skilled operators）, there was no significant difference in operation time and postoperative hospital stay between the two methods （P> 0.05）. The learning curve of RARP reached the highest point when the number of surgical cases accumulated in 40 cases, and the curve decreased steadily after 40 cases. Conclusion： For skilled surgeons, there is no significant difference between RARP and LRP in operation time, intraoperative bleeding and postoperative hospital stay after neoadjuvant hormonal therapy. The learning curve of RARP is not affected by neoadjuvant hormonal therapy.
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