There Are No Differences in Positive Surgical Margin Rates or Biochemical Failure–Free Survival among Patients Receiving Open, Laparoscopic, or Robotic Radical Prostatectomy: A Nationwide Cohort Study from the National Cancer Database

Abstract

Purpose: To estimate the rates of positive surgical margin (PSM) and biochemical failure–free survival (BFS) among patients with prostate cancer (PC) receiving open, laparoscopic, or robotic radical prostatectomy (RP). Patients and Methods: The patients were men enrolled in the Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP. After adjustment for confounders, logistic regression was used to model the risk of PSM following RP. After adjustment for confounders, Cox proportional regression was used to model the time from the index (i.e., surgical) date to biochemical recurrence. Results: The adjusted odds ratios (95% CIs) of PSM risk after propensity score adjustment for laparoscopic versus open, robotic versus open, and robotic versus laparoscopic RP 95% CIs were 1.25 (0.88 to 1.77; p = 0.2064), 1.16 (0.88 to 1.53; p = 0.2847), and 0.93 (0.70 to 1.24; p = 0.6185), respectively. The corresponding adjusted hazard ratios (95% CIs) of risk of biochemical failure after propensity score adjustment were 1.16 (0.93 to 1.47; p = 0.1940), 1.10 (0.83 to 1.47; p = 0.5085), and 0.95 (0.74 to 1.21; p = 0.6582). Conclusions: No significant differences in PSM or BFS were observed among patients receiving open, laparoscopic, or robotic RP.

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

“… 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

“…Nevertheless, the Taiwan Cancer Registry Administration often randomly reviews charts and interviews patients to verify diagnosis accuracy, and hospitals with outlier chargers or practices may be audited and heavily penalized if malpractice or discrepancies are identified. Third, RP techniques are improving with the development of open, laparoscopic, and robotic methods [21]. Modern surgical techniques were not analyzed in our study.…”

“…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

“…Chang et al [2] reported the difference in oncologic outcomes among prostatectomy modalities, such as open, laparoscopic, and robotic surgeries, using the National Cancer Database in Taiwan. 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.…”