Comparison of Perioperative and Early Oncologic Outcomes Between Open and Robotic-Assisted Laparoscopic Prostatectomy in a Contemporary Population-Based Cohort.

To compare rates of positive surgical margins (PSM), use of postoperative radiation therapy (RT), and perioperative outcomes between robotic-assisted laparoscopic (RALP) and open radical prostatectomy (ORP) in a contemporary population-based cohort.

Within the National Cancer Database from 2010 through 2011, patients undergoing RALP (n=73,131) and ORP (n=23,804) for non-metastatic prostate adenocarcinoma were identified. Covariates included: age, race, Charlson Comorbidity index (CCI), PSA, biopsy Gleason score (bGS), clinical stage (cT), final GS (pGS), pathologic T stage (pT), lymph node dissection (LND), nodal status (pN), facility type, hospital volume and year of surgery. Multivariable logistic regression (MVR) was used to identify factors associated with PSM, use of adjuvant/salvage RT, prolonged length of stay (LOS), readmission, and 30-day mortality. Outcomes were also compared in 1:1 propensity-matched cohorts.

Analysis of propensity matched cohorts showed RALP reduced the risk of PSM (OR: 0. 88, 95% CI: 0. 83-0. 93, p<0. 01), use of RT (OR: 0. 71, 95% CI: 0. 63-0. 80, p<0. 01) and 30-day mortality (OR: 0. 28, 95% CI: 0. 13-0. 60 p<0. 01). The protective effect of RALP for PSM was among pT2 patients only (pT2: OR 0. 85, 95% CI: 0. 79-0. 91, p<0. 01; pT3: OR 0. 94, 95% CI: 0. 86-1. 04 p=0. 2). Similar results were obtained using MVR.

In a contemporary large national cohort, RALP was independently associated with clinically meaningful reductions in PSM, postoperative RT and 30-day mortality compared to ORP. The oncologic benefit was primarily among patients with organ-confined disease. Limitations are those associated with any observational study, namely, the potential for bias due to unmeasured confounders.

The Journal of urology. 2016 Feb 06 [Epub ahead of print]

Shane M Pearce, Joseph J Pariser, Theodore Karrison, Sanjay G Patel, Scott E Eggener

Section of Urology, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL. Section of Urology, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL. , Department of Public Health Sciences, The University of Chicago Medicine and Biological Sciences, Chicago, IL. , Section of Urology, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL. , Section of Urology, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL.

PubMed