SAN DIEGO, CA USA (UroToday.com) - With continued debate regarding the oncologic efficacy of open, laparoscopic, and robotic-assisted radical prostatectomy, a multi-institutional group of authors attempted to compare these modalities using propensity score matching – a statistical approach that attempts to reduce selection bias by controlling for confounding variables.
The authors collected data from 22 403 patients with prostate cancer who underwent surgery from 2000 to 2010, at 15 institutions, by over 35 surgeons. Propensity score-based adjustment was utilized on the basis of age, preoperative PSA, postoperative Gleason score, and pathologic stage. Following adjustment, both laparoscopic and robotic minimally invasive techniques demonstrated lower positive surgical margin rates than the open technique with the robotic approach reducing the margin rate by over 10%.
The authors conclude the observed difference in positive surgical margin rates in favor of LRP and RARP using propensity score matching could be due to unmeasureable confounding variables. As one participant in the discussion commented privately, “unmeasureable confounders are present in almost all types of non-randomized studies, and it is difficult to control for these variables. However, in the absence of randomized trials, these approaches are the best tools we have.”
These results add to the body of evidence supporting improved outcomes with minimally invasive approaches to prostatectomy. Although these are inferior to long-term oncologic outcomes, these data suggest that outcomes for laparoscopic and robotic approaches do not appear to be inferior to the traditional open method.
Abstract Title: Comparative analyses of surgical modalities for the management of prostate cancer: A multi-institutional study of positive surgical margin rates on 22 403 patients
Presented by Abhishek Srivastava, Prasanna Sooriakumaran, Shahrokh Shariat, Steve Williams, IngeHeus, Michael Rink, Rafael Sanchez-Salas, Felix Chun, Thomas Chromecki, Peter Wiklund, Monique Roobol, Reza Ghavamian, and Ashutosh Tewari at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Anthony T. Corcoran, MD