Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer (PCa). Its adoption has been driven by market forces and patient preference, and debate continues regarding whether it offers improved outcomes to justify higher cost relative to open surgery. We examined comparative effectiveness of robot assisted (RARP) versus open radical prostatectomy (ORP) in cancer control and survival in a nationally representative population.
Population based observational cohort study of PCa patients undergoing RARP and ORP during 2003-2012 captured in Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Propensity score matching and time to event analysis was used to compare all-cause mortality, prostate cancer-specific mortality and use of additional treatment following surgery.
6,430 RARP and 9,161 ORP performed during 2003-2012 were identified. RARP increased in use from 13.6% to 72.6% in 2003-2004 to 72.6% in 2011-2012. After median follow-up of 6.5 years (IQR 5.2-7.9), RARP was associated with equivalent risk of all-cause mortality (Hazard Ratio [HR] 0.85, [0.72-1.01]) and similar cancer-specific mortality (HR 0.85, [0.50-1.43]) versus ORP. RARP was also associated with less use of additional treatment (HR 0.78, [0. 70-0.86]).
RARP has comparable intermediate cancer control, as evidenced by less use of additional postoperative cancer therapies and equivalent cancer-specific and overall survival. Longer-term follow-up is needed to assess for differences in PCa-specific survival, which was similar during intermediate follow-up. Our findings have significant quality and cost implications and provide reassurance regarding the adoption of more expensive technology in absence of randomized controlled trials.
The Journal of urology. 2016 Oct 05 [Epub ahead of print]
Jim H Hu, Padraic O'Malley, Bilal Chughtai, Abby Isaacs, Jialin Mao, Jason D Wright, Dawn Hershman, Art Sedrakyan
Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY., Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Department of Urology, Dalhousie University, Halifax, Canada. Electronic address: ., Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY., Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY., Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.