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Platinum Priority – Prostate Cancer
Editorial by R. Jeffrey Karnes, Steven Joniau, Michael L. Blute and Hendrik Van Poppel on pp. 673–675 of this issue

Comparative Effectiveness of Robot-assisted Versus Open Radical Prostatectomy Cancer Control

By: Jim C. Hu a lowast , Giorgio Gandaglia b c , Pierre I. Karakiewicz b g , Paul L. Nguyen d , Quoc-Dien Trinh e , Ya-Chen Tina Shih f , Firas Abdollah b g , Karim Chamie a , Jonathan L. Wright h , Patricia A. Ganz i and Maxine Sun b

European Urology, Volume 66 Issue 4, October 2014, Pages 666-672

Published online: 01 October 2014

Keywords: Robotic-assisted surgery, Positive margins, Cancer control, Radical prostatectomy

Abstract Full Text Full Text PDF (280 KB) Patient Summary

Abstract

Background

Robot-assisted radical prostatectomy (RARP) remains controversial, and no improvement in cancer control outcomes has been demonstrated over open radical prostatectomy (ORP).

Objective

To examine population-based, comparative effectiveness of RARP versus ORP pertaining surgical margin status and use of additional cancer therapy.

Design, setting, and participants

This was a retrospective observational study of 5556 RARP and 7878 ORP cases from 2004 to 2009 from Surveillance Epidemiology and End Results–Medicare linked data.

Intervention

RARP versus ORP.

Outcome measurements and statistical analysis

Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of RP surgical margin status and use of additional cancer therapy (radiation therapy [RT] or androgen deprivation therapy [ADT]) by surgical approach.

Results and limitations

In the propensity-adjusted analysis, RARP was associated with fewer positive surgical margins (13.6% vs 18.3%; odds ratio [OR]: 0.70; 95% confidence interval [CI], 0.66–0.75), largely because of fewer RARP positive margins for intermediate-risk (15.0% vs 21.0%; OR: 0.66; 95% CI, 0.59–0.75) and high-risk (15.1% vs 20.6%; OR: 0.70; 95% CI, 0.63–0.77) disease. In addition, RARP was associated with less use of additional cancer therapy within 6 mo (4.5% vs 6.2%; OR: 0.75; 95% CI, 0.69–0.81), 12 mo (OR: 0.73; 95% CI, 0.62–0.86), and 24 mo (OR: 0.67; 95% CI, 0.57–0.78) of surgery. Limitations include the retrospective nature of the study and the absence of prostate-specific antigen levels to determine biochemical recurrence.

Conclusions

RARP is associated with improved surgical margin status relative to ORP for intermediate- and high-risk disease and less use of postprostatectomy ADT and RT. This has important implications for quality of life, health care delivery, and costs.

Patient summary

Robot-assisted radical prostatectomy (RP) versus open RP is associated with fewer positive margins and better early cancer control because of less use of additional androgen deprivation and radiation therapy within 2 yr of surgery.

Take Home Message

Although robot-assisted radical prostatectomy (RARP) is more costly than open radical prostatectomy, our population-based study demonstrates that RARP is associated with fewer positive surgical margins and less use of additional cancer therapy within 2 yr postoperatively.

Keywords: Robotic-assisted surgery, Positive margins, Cancer control, Radical prostatectomy.

Footnotes

a Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

b Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada

c Department of Urology, Universita Vita-Salute San Raffaele, Milan, Italy

d Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA

e Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA

f Section of Hospital Medicine, Department of Medicine Program in the Economics of Cancer, University of Chicago, Chicago, IL, USA

g Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada

h Department of Urology, University of Washington School of Medicine, and Fred Hutchinson Cancer Research Center, Seattle, WA, USA

i Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center, Fielding School of Public Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

lowast Corresponding author. Department of Urology, David Geffen School of Medicine at UCLA, 924 Westwood Blvd., Suite 1000, Los Angeles, CA 90024, USA. Tel. +1 310 405 1467.

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