Radical prostatectomy (RP) can be performed using an open (ORP), laparoscopic (LRP) or robotic (RARP) approach. Most studies, even in experienced centers, have not provided solid evidence demonstrating better outcomes when using the robotic approach. In addition, one of the remaining concerns about RARP is its cost effectiveness, leading to no reimbursement for this surgical technique in some countries and thus health care inequality. We used data from a French national registry to improve knowledge of RP outcomes in a real-world scenario in order to guide and inform health care decision-makers. A total of 21 213 RP procedures were performed in 645 French centers in 2021 (ORP 20%, LRP 25%, and RARP 55% of cases). ORP was associated with longer hospital stay (p < 0.001), higher rates of postoperative complications (p < 0.001), fewer days out of hospital within 90 d of surgery (81.7 vs 83.6 vs 84.9 d for ORP vs LRP vs RARP; p < 0.00), and higher hospitalization costs (€2424 vs €1789 vs €1302). RARP is an optimal and cost-effective approach, with several advantages over ORP. Our data can be used by health care decision-makers to facilitate access to and reimbursement for the robotic approach for RP indications. PATIENT SUMMARY: For men with prostate cancer for whom surgery is recommended, surgeons can remove the prostate using open surgery or a keyhole approach with or without robot assistance. Open surgery has higher costs, more complications, and longer hospital stays.
European urology oncology. 2023 Oct 18 [Epub ahead of print]
Michael Baboudjian, Annabelle Grabia, Eric Barret, Romain Mathieu, François Rozet, Charles-Edouard Lequeu, Morgan Rouprêt, Guillaume Ploussard
Department of Urology, North Academic Hospital, AP-HM, Marseille, France. Electronic address: ., Medical Information and Data Department, Programme de Médicalisation des Systèmes d'Informations, Ramsay Santé, Paris, France., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Urology, CHU Rennes, Rennes, France., Department of Urology, GRC 5 Predictive Onco-Uro, Sorbonne University, Pitie-Salpetriere Hospital, AP-HP, Paris, France., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France; IUCT Oncopole, Toulouse, France.