Comparative Effectiveness of Robot-assisted Versus Open Radical Prostatectomy Cancer Control |
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| Authors: | Jim C. Hu Giorgio Gandaglia Pierre I. Karakiewicz Paul L. Nguyen Quoc-Dien Trinh Ya-Chen Tina Shih Firas Abdollah Karim Chamie Jonathan L. Wright Patricia A. Ganz Maxine Sun |
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| Affiliation: | 1. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;2. Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada;3. Department of Urology, Universita Vita-Salute San Raffaele, Milan, Italy;4. Department of Radiation Oncology, Brigham and Women''s Hospital, Boston, MA, USA;5. Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women''s Hospital, Boston, MA, USA;6. Section of Hospital Medicine, Department of Medicine Program in the Economics of Cancer, University of Chicago, Chicago, IL, USA;g Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;h Department of Urology, University of Washington School of Medicine, and Fred Hutchinson Cancer Research Center, Seattle, WA, USA;i Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center, Fielding School of Public Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA |
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| Abstract: | ![]()
BackgroundRobot-assisted radical prostatectomy (RARP) remains controversial, and no improvement in cancer control outcomes has been demonstrated over open radical prostatectomy (ORP).ObjectiveTo examine population-based, comparative effectiveness of RARP versus ORP pertaining surgical margin status and use of additional cancer therapy.Design, setting, and participantsThis was a retrospective observational study of 5556 RARP and 7878 ORP cases from 2004 to 2009 from Surveillance Epidemiology and End Results–Medicare linked data.InterventionRARP versus ORP.Outcome measurements and statistical analysisPropensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of RP surgical margin status and use of additional cancer therapy (radiation therapy [RT] or androgen deprivation therapy [ADT]) by surgical approach.Results and limitationsIn the propensity-adjusted analysis, RARP was associated with fewer positive surgical margins (13.6% vs 18.3%; odds ratio [OR]: 0.70; 95% confidence interval [CI], 0.66–0.75), largely because of fewer RARP positive margins for intermediate-risk (15.0% vs 21.0%; OR: 0.66; 95% CI, 0.59–0.75) and high-risk (15.1% vs 20.6%; OR: 0.70; 95% CI, 0.63–0.77) disease. In addition, RARP was associated with less use of additional cancer therapy within 6 mo (4.5% vs 6.2%; OR: 0.75; 95% CI, 0.69–0.81), 12 mo (OR: 0.73; 95% CI, 0.62–0.86), and 24 mo (OR: 0.67; 95% CI, 0.57–0.78) of surgery. Limitations include the retrospective nature of the study and the absence of prostate-specific antigen levels to determine biochemical recurrence.ConclusionsRARP is associated with improved surgical margin status relative to ORP for intermediate- and high-risk disease and less use of postprostatectomy ADT and RT. This has important implications for quality of life, health care delivery, and costs.Patient summaryRobot-assisted radical prostatectomy (RP) versus open RP is associated with fewer positive margins and better early cancer control because of less use of additional androgen deprivation and radiation therapy within 2 yr of surgery. |
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| Keywords: | Robotic-assisted surgery Positive margins Cancer control Radical prostatectomy |
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