Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study

Abstract

Background Robot-assisted laparoscopic radical prostatectomy (RALP) has become increasingly common; however, there have been no nationwide, population-based, non–claims-based studies to evaluate differences in outcomes between RALP and open radical retropubic prostatectomy (RRP). Objective To determine surgical, oncologic, and health-related quality of life (HRQOL) outcomes following RALP and RRP in a nationwide cohort. Design, setting, and participants We identified 903 men in the Health Professionals Follow-up Study diagnosed with prostate cancer between 2000 and 2010 who underwent radical prostatectomy using RALP (n = 282) or RRP (n = 621) as primary treatment. Intervention Radical prostatectomy. Outcome measurements and statistical analysis We compared patients undergoing RALP or RRP across a range of perioperative, oncologic, and HRQOL outcomes. Results and limitations Use of RALP increased during the study period, constituting 85.2% of study subjects in 2009, up from 4.5% in 2003. Patients undergoing RALP compared to RRP were less likely to have a lymph node dissection (51.5% vs 85.4%; p < 0.0001), had less blood loss (207.4 ml vs 852.3 ml; p < 0.0001), were less likely to receive blood transfusions (4.3% vs 30.3%; p < 0.0001), and had shorter hospital stays (1.8 d vs 2.9 d; p < 0.0001). Surgical, oncologic, and HRQOL outcomes did not differ significantly among the groups. In multivariate logistic regression models, there were no significant differences in 3- or 5-yr recurrence-free survival comparing RALP versus RRP (hazard ratios: 0.98 [95% confidence interval (CI), 0.46–2.08] and 0.75 [95% CI, 0.18–3.11], respectively). Conclusions In a nationwide cohort of patients undergoing surgical treatment for prostate cancer, RALP was associated with shorter hospital stay, and lower blood loss and transfusion rates than RRP. Surgical oncologic and HRQOL outcomes were similar between groups. Patient summary We studied men throughout the United States with prostate cancer who underwent surgical removal of the prostate. We found that robot-assisted laparoscopic radical prostatectomy resulted in shorter hospital stay, less blood loss, and fewer blood transfusions than radical retropubic prostatectomy. There were no differences in cancer control or health-related quality of life.

4.3 Roboterassistierte radikale Prostatektomie

“…Sowohl für die RARP als auch die laparoskopische radikale Prostatektomie (LRP) konnten aufgrund des minimalinvasiven Zugangs ein signifi kant geringerer Blutverlust und geringere Transfusionsraten nachgewiesen werden [15,16]. Bezüglich der periund postoperativen Komplikationsraten schnitt die RARP in retrospektiven Analysen ebenfalls häufi g besser ab als die ORP [14,16].…”

Editorial Comment to Stratified analysis of 800 Asian patients after robot‐assisted radical prostatectomy with a median 64 months of follow up

“…4 However, long-term oncological and functional outcomes appear equivalent between the two procedures. 5 The biggest issue regarding RARP is the large expenditure associated with disposable instruments predetermined by the manufacturer and annual maintenance of the robot. From the viewpoint of cost-effectiveness, these extra expenditures are interpreted to be paid for improving the short-term postoperative recovery but not the long-term oncological and functional outcomes.…”

Robotic-Assisted Laparoscopic Radical Prostatectomy

“…58 See Table 4 for a review of positive surgical margin rates in studies comparing RALRP and ORP. 35,36,[43][44][45][46] …”