A LARGE nationwide French cohort study has found that robot-assisted radical prostatectomy (RARP) is associated with significantly fewer short-term postoperative complications compared with both open and laparoscopic approaches. The findings add robust real-world evidence to ongoing discussions about the safety of minimally invasive prostate cancer surgery.
Using national administrative health data, researchers analysed outcomes for men undergoing open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or RARP. Short-term complications occurring during hospitalisation were the primary endpoint. After adjustment for patient demographics, comorbidities, and surgical factors, both minimally invasive techniques were associated with lower odds of complications compared with open surgery.
Robotic Prostatectomy Reduces Early Postoperative Risk
The strongest effect was observed with RARP. Patients undergoing robot-assisted surgery had a 49% lower risk of short-term complications compared with those receiving open prostatectomy (adjusted odds ratio [aOR] 0.51; 95% CI 0.48–0.55). Laparoscopic prostatectomy was also associated with a reduced risk, though to a lesser extent, showing a 37% reduction in odds relative to open surgery (aOR 0.63; 95% CI 0.58–0.68).
These findings support the growing adoption of robotic techniques in prostate cancer surgery. Reduced tissue trauma, improved visualisation, and greater surgical precision offered by robotic platforms have previously been suggested as contributors to improved perioperative outcomes, and the current data reinforce these potential benefits in routine clinical practice.
Limitations in Robotic Prostatectomy Outcome Analysis
However, the authors also highlighted important nuances. While overall complication rates were lower with minimally invasive techniques, postoperative hernia rates were slightly higher following laparoscopic and robot-assisted procedures compared with open surgery. This suggests that technique-specific risks persist and should be considered during surgical planning and patient counselling.
The investigators emphasised that the study’s observational design limits causal interpretation, and that reliance on administrative coding may underestimate certain complications. They called for further prospective studies with longer follow-up to evaluate functional outcomes, oncological control, and longer-term complications.
Overall, the study provides compelling real-world evidence that robot-assisted radical prostatectomy offers a significant short-term safety advantage, while highlighting the need for individualised decision-making based on patient characteristics, surgeon expertise, and available resources.
Reference
Nunes P et al. Comparison of short-term complications after open, laparoscopic and robot-assisted radical prostatectomy. BJU Int. 2025; doi:10.1111/bju.70076.
