Prostatectomía radical anatómica anterógrada abierta versus cirugía robótica: resultados comparativos de un centro académico de formación

Autores/as

  • 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
  • Daniela Bouzas Rodeiro Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil. https://orcid.org/0000-0002-8184-4445
  • Ana Beatriz da Silva Polonia Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil.
  • Felipe Vaz Chilao Guedes Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto (HUPE), Río de Janeiro, Brasil.
  • Alexandre Rodrigues Óliveira 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

Palabras clave:

cáncer de próstata, prostatectomía radical, cirugía robótica, técnica anterógrada abierta, formación quirúrgica, rentabilidad

Resumen

Objetivo: comparar los resultados perioperatorios y oncológicos entre la prostatectomía radical anatómica anterógrada abierta (AORP) y la prostatectomía radical asistida por robot (RARP), ambas realizadas siguiendo los mismos principios de disección, en un único centro académico de formación.

Materiales y métodos: se analizó una cohorte retrospectiva de 252 pacientes consecutivos con cáncer de próstata localizado sometidos a prostatectomía radical en un hospital universitario público. La técnica AORP se realizó en 126 pacientes (2016–2019) y la RARP en 126 pacientes (2021–2023). Los desenlaces evaluados incluyeron tiempo operatorio, pérdida sanguínea estimada, duración de la hospitalización, complicaciones posoperatorias (Clavien–Dindo) y recurrencia bioquímica a 1 y 2 años. Se aplicaron pruebas estadísticas no paramétricas y categóricas (p < 0.05).

Resultados: los pacientes sometidos a RARP eran más jóvenes (mediana 61 vs. 63 años, p=0.009) y presentaban grados ISUP más bajos. La RARP mostró tiempos operatorios más prolongados (203 vs. 140 minutos, p<0.001), mientras que la pérdida sanguínea, la estancia hospitalaria y las tasas de complicaciones fueron similares entre los grupos. Las tasas de recurrencia bioquímica fueron de 9.6 % vs. 18.3 % al año (p = 0.069) y fueron idénticas a los 2 años (18.3 % en ambos grupos, p = 1.000).

Conclusiones: el abordaje anatómico anterógrado abierto obtuvo resultados perioperatorios y oncológicos equivalentes a la cirugía robótica, a pesar de ser realizado predominantemente por residentes en un entorno de formación con recursos limitados. La AORP representa una alternativa quirúrgica segura, eficaz y costo-eficiente para la prostatectomía radical en contextos donde los sistemas robóticos no están disponibles.

Biografía del autor/a

  • 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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Publicado

2026-08-21

Número

Vol. 86 Núm. 4 (2026): Julio-Agosto

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Artículos originales

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Derechos de autor 2026 Revista Mexicana de Urología

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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.