Comparative Effectiveness of Prostate Cancer Surgical Treatments: A Population Based Analysis of Postoperative Outcomes

Abstract

Background-Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown, despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic (with or without robotic assistance) versus open radical prostatectomy in terms of postoperative outcomes and subsequent cancer-directed therapy.

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

“…Lowrance and colleagues compared the 90-day general medical or surgical complications, and 365-day genitourinary or bowel complications, of 4,697 patients treated with ORP with those of 1,006 patients treated with minimally invasive RP (MRP)[17]. After adjusting for patient and tumor characteristics, as well as year of surgery and surgeon volume, procedure type (ORP vs. MRP) was not significantly associated with a postoperative complication (odds ratio [OR] for general medical or surgical complications: 0.93; 95% confidence interval [CI]: 0.77–1.14; p = 0.49; OR for genitourinary or bowel complications: 0.96; 95% CI: 0.76–1.22; p = 0.74).…”

“…If the majority of prostatectomies performed at a given center are performed with an open approach, then one would expect superior outcomes for ORP patients because of the well-known volume/outcome relationship with RP[22]. The same volume/outcome relationship holds true for RALP[17]. …”

“…In a comprehensive review of the literature comparing open, robotic, and traditional laparoscopic RP, Ficarra et al found no difference between RALP and ORP (relative risk: 1.33; 95% CI: 0.64–2.74; p = 0.44) in their cumulative analysis of overall complications. When the two recently published population-based comparative effectiveness studies[12,17] are considered with the findings from Ficarra and associates[15], there appear to be minimal differences in overall perioperative complication rates between ORP and RALP. The difference in the rate of complications between surgeons seems larger than that between surgical approaches.…”

“…The two comparative effectiveness population-based studies by Hu et al and Lowrance et al reported a shorter median LOS for MRP patients (2 vs. 3 days, p < 0.001)[12,17]. After adjusting for the effects of patient age, comorbidity, tumor characteristics, year of surgery, and surgeon volume, Lowrance et al reported a 35% shorter LOS for MRP patients.…”

“…After adjusting for the effects of patient age, comorbidity, tumor characteristics, year of surgery, and surgeon volume, Lowrance et al reported a 35% shorter LOS for MRP patients. In addition, increasing surgeon volume was associated with decreasing LOS ( p < 0.001)[17]. In a comparative study from the Mayo Clinic, 29% of RALP vs. 19% of ORP patients had a 1-day LOS ( p = 0.004).…”