Mehrdad Alemozaffar1, Martin Sanda2, Derek Yecies3, Lorelei A Mucci4, Meir J Stampfer4, Stacey A Kenfield5. 1. USC Institute of Urology, Keck Medical Center at USC, Los Angeles, CA, USA. Electronic address: malemozaffar@gmail.com. 2. Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. 3. Boston University School of Medicine, Boston, MA, USA. 4. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 5. Department of Urology, University of California, San Francisco, CA, USA.
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.
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.
Authors: Daniel A Barocas; Shady Salem; Yakup Kordan; S Duke Herrell; Sam S Chang; Peter E Clark; Rodney Davis; Roxelyn Baumgartner; Sharon Phillips; Michael S Cookson; Joseph A Smith Journal: J Urol Date: 2010-01-18 Impact factor: 7.450
Authors: Florian R Schroeck; Leon Sun; Stephen J Freedland; David M Albala; Vladimir Mouraviev; Thomas J Polascik; Judd W Moul Journal: BJU Int Date: 2008-04-02 Impact factor: 5.588
Authors: Martin G Sanda; Rodney L Dunn; Jeff Michalski; Howard M Sandler; Laurel Northouse; Larry Hembroff; Xihong Lin; Thomas K Greenfield; Mark S Litwin; Christopher S Saigal; Arul Mahadevan; Eric Klein; Adam Kibel; Louis L Pisters; Deborah Kuban; Irving Kaplan; David Wood; Jay Ciezki; Nikhil Shah; John T Wei Journal: N Engl J Med Date: 2008-03-20 Impact factor: 91.245
Authors: A V D'Amico; R Whittington; S B Malkowicz; D Schultz; K Blank; G A Broderick; J E Tomaszewski; A A Renshaw; I Kaplan; C J Beard; A Wein Journal: JAMA Date: 1998-09-16 Impact factor: 56.272
Authors: Sandip M Prasad; Nancy L Keating; Qin Wang; Chris L Pashos; Stuart Lipsitz; Jerome P Richie; Jim C Hu Journal: Urology Date: 2008-07-23 Impact factor: 2.649
Authors: Joseph A Smith; Robert C Chan; Sam S Chang; S Duke Herrell; Peter E Clark; Roxy Baumgartner; Michael S Cookson Journal: J Urol Date: 2007-10-22 Impact factor: 7.450
Authors: Denny Yu; Cem Dural; Melissa M B Morrow; Liyun Yang; Justin W Collins; Susan Hallbeck; Magnus Kjellman; Mikael Forsman Journal: Surg Endosc Date: 2016-08-05 Impact factor: 4.584
Authors: Peter A Elliott; Stephanie Hsiang; Ramkishen Narayanan; James Bierylo; Shu-Ching Chang; Przemyslaw Twardowski; Timothy G Wilson Journal: J Robot Surg Date: 2021-01-11
Authors: Aaron M Potretzke; Eric H Kim; Brent A Knight; Barrett G Anderson; Alyssa M Park; R Sherburne Figenshau; Sam B Bhayani Journal: J Robot Surg Date: 2016-04-15
Authors: Brock O'Neil; Tatsuki Koyama; JoAnn Alvarez; Ralph M Conwill; Peter C Albertsen; Matthew R Cooperberg; Michael Goodman; Sheldon Greenfield; Ann S Hamilton; Karen E Hoffman; Richard M Hoffman; Sherrie H Kaplan; Janet L Stanford; Antoinette M Stroup; Lisa E Paddock; Xiao-Cheng Wu; Robert A Stephenson; Matthew J Resnick; Daniel A Barocas; David F Penson Journal: J Urol Date: 2015-09-03 Impact factor: 7.450
Authors: Arunan Sujenthiran; Julie Nossiter; Matthew Parry; Susan C Charman; Ajay Aggarwal; Heather Payne; Prokar Dasgupta; Noel W Clarke; Jan van der Meulen; Paul Cathcart Journal: BJU Int Date: 2017-11-15 Impact factor: 5.588
Authors: Graham R Hale; Mohammed Shahait; David I Lee; Daniel J Lee; Ryan W Dobbs Journal: Patient Prefer Adherence Date: 2021-06-23 Impact factor: 2.711