Comparative assessment of the learning curve of retropubic, laparoscopic, perineal, and robot-assisted radical prostatectomy
Introduction. The learning curve (LC) of radical prostatectomy (RP) is an actual problem in contemporary urology.Objective. To assess the LC of retropubic (rpRP), perineal (plRP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP).Materials and methods. The study included 400 patients with localized or locally advanced prostate cancer (T1cT3bN0M0) who underwent rpRP, plRP, LRP or RARP performed by a single surgeon. Exclusion criteria: refusal of surgical treatment, metastatic prostate cancer, primary multiple cancer, neoadjuvant hormonal, radiation or chemotherapy.Results. Progressive improvement of metric indicators was noted in all groups as the surgical technique was mastered. Maximum rates of reaching the plateau of satisfactory functional and early oncological results were demonstrated in the RARP group after 25 - 50 procedures. In terms of the duration of the surgery, the LRP group showed the longest mastering period of 75 - 100 cases. Regression of blood loss volume requires 50 - 75 procedures in the rpRP and LRP groups, and 25 - 50 approaches in the rpRP and RARP groups. RARP demonstrates advantages in the context of minimization of catheterization time and inpatient period (25 - 50 cases). rpRP is not only associated with a maximum amount (n = 30) and frequency (21,0%) of complications, but also with a relatively long period of reaching a plateau of 50 - 75 cases. The stabilization of functional results is proceeding at the maximum pace in the RARP group at 25 - 50 procedures, in the other groups at 50 - 75 cases. Oncological safety (positive surgical margin) in the LRP, rpRP and RARP groups is achievable after 25 - 50 cases, in the rpRP group at 50 - 75 cases.Conclusion. The period of RP mastering depends on surgical approaches. RARP demonstrates the shortest LC duration.