Open anterograde anatomic radical prostatectomy: a resource-sparing alternative to robotic surgery in a university training center

Abstract

Purpose: to compare perioperative and oncological outcomes between open anterograde anatomic radical prostatectomy (AORP) and robot-assisted radical prostatectomy (RARP), both performed following the same dissection principles, in a single academic training center. Materials and methods: a retrospective cohort of 252 consecutive patients with localized prostate cancer undergoing radical prostatectomy at a public university hospital was analyzed. AORP was performed in 126 patients (2016–2019) and RARP in 126 (2021–2023). Evaluated outcomes included operative time, estimated blood loss, length of hospitalization, postoperative complications (Clavien–Dindo), and biochemical recurrence at 1 and 2 years. Non-parametric and categorical statistical tests were applied (p < 0.05). Results: patients undergoing RARP were younger (median 61 vs. 63 years, p = 0.009) and presented with lower ISUP grades. RARP demonstrated longer operative times (203 vs. 140 minutes, p < 0.001), while blood loss, hospital stay, and complication rates were similar between groups. Biochemical recurrence rates were 9.6 % vs. 18.3 % at 1 year (p = 0.069), and identical at 2 years (18.3 % in both groups, p =1.000). Conclusions: in this retrospective cohort, no statistically significant differences were observed between AORP and RARP in estimated blood loss, length of hospital stay, postoperative complications, or biochemical recurrence during the two-year follow-up period. Although these findings should not be interpreted as evidence of equivalence, they support the feasibility and perioperative safety of AORP as an alternative to robotic radical prostatectomy, particularly in settings where access to robotic systems is limited or unavailable.