Comparative Effectiveness of Robot-assisted Versus Open Radical Prostatectomy Cancer Control

• Published in: European urology 2014-10, Vol.66 (4), p.666-672
• Main Authors: Hu, Jim C, Gandaglia, Giorgio, Karakiewicz, Pierre I, Nguyen, Paul L, Trinh, Quoc-Dien, Shih, Ya-Chen Tina, Abdollah, Firas, Chamie, Karim, Wright, Jonathan L, Ganz, Patricia A, Sun, Maxine
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cancer control; Cohort Studies; Confidence Intervals; Follow-Up Studies; Humans; Linear Models; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Nephrology. Urinary tract diseases; Odds Ratio; Patient Safety; Positive margins; Prostate-Specific Antigen - blood; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radical prostatectomy; Retrospective Studies; Risk Assessment; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotic-assisted surgery; Treatment Outcome; Tumors; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2014.02.015

Abstract Background Robot-assisted radical prostatectomy (RARP) remains controversial, and no improvement in cancer control outcomes has been demonstrated over open radical prostatectomy (ORP). Objective To examine population-based, comparative effectiveness of RARP versus ORP pertaining surgical margin status and use of additional cancer therapy. Design, setting, and participants This 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. Intervention RARP versus ORP. Outcome measurements and statistical analysis Propensity-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 limitations In 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. Conclusions RARP 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 summary Robot-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.