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

Authors

  • Fabricio Borges Carrerette Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil. https://orcid.org/0000-0002-7678-7589
  • Dra. Daniela B. Rodeiro Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil. https://orcid.org/0000-0002-8184-4445
  • Dra. Ana B. S. Polonia Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil.
  • Dr. Felipe V. C. Guedes Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil.
  • Dr. Alexandre R. Oliveira Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil. https://orcid.org/0009-0000-4326-424X

DOI:

https://doi.org/10.48193/w5xek948

Keywords:

prostate cancer, radical prostatectomy, robotic surgery, open anterograde technique, surgical training, cost-effectiveness

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.

Author Biography

  • Fabricio Borges Carrerette, Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil.

    Fabricio Borges Carrerette, MD, PhD, is a urologist, surgeon-scientist, and associate professor at the State University of Rio de Janeiro (UERJ), Brazil. He serves in the Department of Urology at the Pedro Ernesto University Hospital (HUPE/UERJ), where he works in urologic oncology with a focus on prostate, bladder, and kidney cancer. His clinical practice encompasses high-complexity oncologic surgery, including radical prostatectomy, radical cystectomy, and partial nephrectomy performed through open, laparoscopic, and robotic approaches.

    Dr. Carrerette is the developer of the Open Anterograde Anatomical Radical Prostatectomy (AORP) technique, an innovation created in 2015 at UERJ based on the dissection principles of robotic surgery, designed to expand access to high-quality prostate cancer treatment in resource-constrained health systems. The technique has been validated through multiple scientific publications, including a prospective randomized trial, and is currently being disseminated in Brazil and internationally.

    He is actively involved in clinical research, surgical innovation, and resident training, participating in multicenter studies in urologic oncology and contributing to translational research. Dr. Carrerette also serves as a mentor and educator in undergraduate and postgraduate medical programs, with continuous involvement in surgical teaching and academic leadership.

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Published

2026-08-21

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Vol. 86 No. 4 (2026): July-August

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Original articles

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