Peter Chang1, Andrew A Wagner1, Meredith M Regan2, Joseph A Smith3, Christopher S Saigal4, Mark S Litwin4,5, Jim C Hu6, Matthew R Cooperberg7, Peter R Carroll7, Eric A Klein8, Adam S Kibel9, Gerald L Andriole10, Misop Han11, Alan W Partin11, David P Wood12, Catrina M Crociani1, Thomas K Greenfield13, Dattatraya Patil14, Larry A Hembroff15, Kyle Davis15, Linda Stork15, Daniel E Spratt16, John T Wei17, Martin G Sanda14. 1. Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. 2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. 3. Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Department of Urology, UCLA Center for Health Sciences, Los Angeles, California. 5. Department of Health Policy and Management, UCLA Center for Health Sciences, Los Angeles, California. 6. Department of Urology, Weill Cornell Medicine, New York, New York. 7. Department of Urology, University of California, San Francisco, San Francisco, California. 8. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. 9. Division of Urology, Brigham and Women's Hospital and Harvard Medical School. 10. Department of Urology, Washington University, St. Louis, Missouri. 11. Johns Hopkins University and The Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland. 12. Beaumont Health, Royal Oak, Michigan. 13. Alcohol Research Group, Public Health Institute, Emeryville, California. 14. Department of Urology, Emory University School of Medicine, Atlanta, Georgia. 15. Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing, Michigan. 16. Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio. 17. Department of Urology, University of Michigan, Ann Arbor, Michigan.
Abstract
PURPOSE: Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study. MATERIALS AND METHODS: We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications. RESULTS: Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain. CONCLUSIONS: In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.
PURPOSE: Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study. MATERIALS AND METHODS: We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications. RESULTS: Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain. CONCLUSIONS: In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.
Entities:
Keywords:
prostatectomy; quality of life; robotic surgical procedures
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