Jim C Hu1, Giorgio Gandaglia2, Pierre I Karakiewicz3, Paul L Nguyen4, Quoc-Dien Trinh5, Ya-Chen Tina Shih6, Firas Abdollah3, Karim Chamie7, Jonathan L Wright8, Patricia A Ganz9, Maxine Sun10. 1. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. Electronic address: jchu@mednet.ucla.edu. 2. Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, Universita Vita-Salute San Raffaele, Milan, Italy. 3. Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. 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. 7. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 8. Department of Urology, University of Washington School of Medicine, and Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 9. 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. 10. Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada.
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.
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.
Authors: Felix Preisser; Sebastiano Nazzani; Elio Mazzone; Sophie Knipper; Marco Bandini; Zhe Tian; Alexander Haese; Fred Saad; Kevin C Zorn; Francesco Montorsi; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Pierre I Karakiewicz Journal: World J Urol Date: 2018-10-12 Impact factor: 4.226
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