Comparison of open and robotic-assisted prostatectomy: The University of British Columbia experience

Abstract

Introduction:We assessed outcomes and costs of open prostatectomy (OP) versus robotic-assisted prostatectomy (RAP) at a single tertiary care university hospital. Results:The 2 groups had similar demographics, including mean age (64.7 vs. 64.2) and mean body mass index (27.2 vs. 27.2). The OP group had a higher proportion of higher risk cancers compared to the RAP group (32.5% vs. 8.5%). Mean skin-to-skin operative room time was less for the OP (114.2 vs. 234.1 minutes). Transfusion rates were similar at 1.5% with OP compared to 3.5% with RAP. The mean length of stay was 1.78 days for OP compared to 1.76 days for RAP, for the last 100 patients in each group. The OP group had more high-grade disease in the prostatectomy specimen, with Gleason ≥8 in 23.5% compared to 3.5% in the RAP group. Positive surgical margin rates were comparable at 31% for OP and 24.6% for RAP, and remained similar after stratification for pT2 and pT3 disease. The grade I and II perioperative complication rate (ClavienDindo classification) was lower in the OP group (8.5% vs. 20%). Postoperative stress urinary incontinence rates (4.8% for OP and 4.6% for RAP) and biochemical-free status (91.8% for OP and 96% for RAP) did not differ at 12 months post-surgery. The additional cost of RAP was calculated as $5629 per case. The main limitations of this study are its retrospective nature and lack of validated questionnaires for evaluation of postoperative functional outcomes. Conclusion: While hospital length of stay, transfusion rates, positive surgical margin rates and postoperative urinary incontinence were similar, OP had a shorter operative time and a lower cost compared to the very early experience of RAP. Future parallel prospective analysis will address the impact of the learning curve on these outcomes.

Robot-assisted radical prostatectomy: Another Canadian experience

“…2 In the current Canadian study, the authors present their retrospective, single institution review of perioperative, oncological and functional outcomes for both ORP and RARP. 3,4 Interestingly at this tertiary academic high volume centre (The Vancouver Prostate Centre BC), their findings contrast to previously published outcomes. 5 More specifically, systemic reviews suggest that RARP is advantageous with regards to blood loss, transfusion rates and length of hospital stay.…”

“…In the study by Gagnon and colleagues, ORP and RARP blood loss (402 vs. 287 mL), transfusion rate (1.5% vs. 3.5%) and length of stay (1.95 vs. 1.69 days) were not found to be statistically significant (all p > 0.05). 3 Furthermore, no differences in 90-day non-descriptive Clavien complications were observed. Moreover, in our initial robotic experience at the University of Montreal Hospital Centre in 2012, we compared perioperative outcomes of the first 200 RARP cases to 83 ORP cases performed in the same year (unpublished data).…”

Robotic vs. Retropubic radical prostatectomy in prostate cancer: A systematic review and a meta-analysis update

“…With respect to perioperative variables, pooling data of 18 studies [ 21 , 23 , 24 , 26 , 29 , 32 , 34 , 40 , 54 , 59 , 60 , 64 , 70 , 75 , 78 , 81 , 84 , 85 ] involving 54261 participants indicated that RARP has longer operative time than RRP (WMD: 39.85 minutes; 95% CI: 20.95 to 58.75; P < 0.001) (Figure 2 ). Pooling data of 13 studies [ 10 , 21 , 23 , 29 , 30 , 34 , 40 , 60 , 70 , 75 , 78 , 84 , 85 ] results showed that RARP has less intraoperative blood loss (WMD = -507.67ml; 95% CI: -633.21 to -382.12; P < 0.001) (Figure 3 ).…”

“…Pooled data from the 26 studies [ 9 , 10 , 14 , 21 , 23 , 24 , 26 , 29 , 30 , 34 , 35 , 40 , 44 - 46 , 54 , 59 , 64 , 72 , 73 , 78 , 80 , 82 , 84 ] reported transfusion rate between RARP and RRP, and the results showed that RARP was associated with lower transfusion rate (OR = 0.13; 95% CI: 0.08 to 0.21; P < 0.001) than RRP (Figure 4 ). Pooling data of 5 studies reported on the time to remove catheter, the forest plot showed that RARP had shorter time to remove catheter than RRP group (WMD = -3.04; 95% CI: -4.59 to -1.49; P < 0.001) ( Figure S5 ).…”

Avaliação prospectiva de curva de aprendizado da prostatectomia radical laparoscópica assistida por robótica

“…Uma publicação recente revelou resultados semelhantes aos obtidos com a PRR em relação aos resultados funcionais e às margens cirúrgicas positivas; e ao serem analisados o tempo cirúrgico e os custos do procedimento, melhores resultados foram observados na PRR (Gagnon et al, 2014 …”