Comparison of Oncologic Outcomes and Complications According to Surgical Approach to Radical Prostatectomy: Special Focus on the Perineal Approach

The objective of the study was to compare oncologic outcomes and complications in patients with prostate cancer who underwent radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), or robotic-assisted radical prostatectomy (RARP).We retrospectively reviewed 2617 patients who underwent RPP (n = 673), RRP (n = 396), LRP (n = 223), or RARP (n = 1325) between 1995 and 2013. Clinicopathological outcomes were compared according to surgical approach. Kaplan-Meier and Cox regression analyses were carried out to assess oncologic outcomes. Complications were stratified according to the Clavien classification system.The 5-year biochemical recurrence (BCR)-free survival after RPP was 75.3%, which was higher than for RRP (71.4%; P = .007) and comparable with LRP (76.1%; P = .666) and RARP (75.3%; P = .898). In multivariate analysis, RPP was comparable with LRP (P = .591) and RARP (P = .089) whereas RRP was associated with increased BCR (P .001). No significant difference was seen in 5-year cancer-specific survival (RPP, 99.0%; RRP, 98.7%; LRP, 100.0%; and RARP, 99.8%; P = .071). The 5-year overall survival after RPP was 97.0%, which was lower than for RARP (99.6%; P = .007), but comparable with RRP (96.2%; P = .792) and LRP (99.1%; P = .606). Overall complication rates were 25.1% for RPP, 36.4% for RRP, 16.1% for LRP, and 9.4% for RARP (P .001), respectively. After RPP, wound dehiscence (10.3%) was the most common complication. However, approximately 75% of complications were minor.RPP showed acceptable oncologic outcomes compared with other surgical approaches. Careful attention is required to prevent wound dehiscence.