Effects of 1-Year Hospital Volume on Surgical Margin and Biochemical-Failure-Free Survival in Patients Undergoing Robotic versus Nonrobotic Radical Prostatectomy: A Nationwide Cohort Study from the National Taiwan Cancer Database

Abstract

Purpose: To examine the effect of hospital volume on positive surgical margin (PSM) and biochemical-failure-free survival (BFS) rates in patients with prostate cancer (PC) undergoing robotic-assisted or nonrobotic-assisted radical prostatectomy (RP). Patients and Methods: The patients were men collected in the National Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP from 44 multi-institutes in Taiwan. The logistic regression method was used to analyze the risk from RP to PSM in included patients with hospital volume (i.e., number of patients with PC receiving robotic RP per year), and the Cox proportional hazards method was used to analyze the time from the index date to biochemical recurrence. Results: After propensity score adjustment, compared with hospitals with >100 patients/year, the adjusted odds ratios (aORs; 95% confidence intervals) of PSM in the robotic RP group in hospitals with 1–25, 26–50, and 51–100 patients/year were 2.25 (2.10–3.11), 1.42 (1.25–2.23), and 1.33 (1.13–2.04), respectively (type III p < 0.0001). Sensitivity analysis indicated that the aORs of PSM were 1.29 (1.07–1.81), 1.07 (0.70–1.19), and 0.61 (0.56–0.83), respectively, for patients receiving robotic RP compared with nonrobotic RP within hospitals with 1–25, 26–50, and 51–100 patients/year, respectively. Compared with hospitals with >100 patients/year, the adjusted hazard ratios (aHRs) of biochemical failure in the robotic RP group were 1.40 (1.04–1.67), 1.34 (1.06–1.96), and 1.31 (1.05–2.15) in hospitals with 1–25, 26–50, and 51–100 patients/year, respectively. Conclusions: Hospital volume significantly affected PSM and BFS in robotic RP, but not in nonrobotic RP. When patients with PC want to receive robotic RP, it should be performed in a relatively high-volume hospital (>100 patients/year).

Comparison of Acute and Chronic Surgical Complications Following Robot-Assisted, Laparoscopic, and Traditional Open Radical Prostatectomy Among Men in Taiwan

“… 12 , 13 , 32 The lack of differences in the blood transfusion volume among the 3 RP techniques may be due to the hospital volume effect. 6 In Taiwan, traditional ORP has been performed by highly experienced surgeons for many years, 5 , 6 , 33 which may have minimized the blood volume required for transfusion. Because LRP and RARP are designed to require a low volume of blood for transfusion and because this surgery is conducted in low-volume hospitals, their transfusion volume may not be significantly different in this study.…”

“… 17 The TCRD of the Collaboration Center of Health Information Application contains detailed patient information, such as clinical stage, pathological stage, surgical margin status, surgical procedures, treatment techniques, radiotherapy, chemotherapy regimens, and follow-up visits. 5 , 6 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Our protocols were reviewed and approved by the institutional review board of Tzu-Chi Medical Foundation. Patient consent was waived because data files are deidentified by scrambling the identification codes of both patients and medical facilities and sent to the National Health Research Institutes to form the original files of NHIRD.…”

“… 5 , 6 Currently, 3 common surgery options are available: robot-assisted RP (RARP), laparoscopic RP (LRP), and traditional open RP (ORP). 5 , 6 , 7 , 8 , 9 , 10 , 11 Few studies have compared empirical perioperative and postoperative outcomes of these RP types for patients with PC. 12 , 13 , 14 Strong evidence is lacking for concluding which of the 3 surgery types has the fewest acute and chronic surgical complications.…”

Oncologic Outcomes of Radical Prostatectomy and High-Dose Intensity-Modulated Radiotherapy with Androgen-Deprivation Therapy for Relatively Young Patients with Unfavorable Intermediate-Risk Prostate Adenocarcinoma

“…The Death Registry data are additionally linked to the NHIRD to verify the cause of death and vital status of each patient. The TCRD contains detailed information, such as AJCC stages, surgical procedures, techniques, RT, hormone treatments, and pathologic stages [19][20][21][22][23][24][25][26].…”

Diagnosis and Treatment of Prostate Adenocarcinoma

“…They found no significant differences in the positive surgical margin and biochemical recurrence rate among patients who underwent open, laparoscopic, or robot-assisted radical prostatectomy after propensity score adjustment. They further examined the effect of hospital volume on positive surgical margin and biochemical recurrence-free survival rates in patients with prostate cancer undergoing robot-assisted or non-robot-assisted radical prostatectomy [3]. They found that hospital volume significantly affected positive surgical margin rates and biochemical recurrence-free survival rates and concluded that robot-assisted radical prostatectomy should be performed in a relatively high-volume hospital (>100 patients/year), if patients with prostate cancer want to receive it.…”