Health Economic Analysis of Open and Robot-assisted Laparoscopic Surgery for Prostate Cancer Within the Prospective Multicentre LAPPRO Trial

Forsmark, Annabelle; Gehrman, Jacob; Angenete, Eva; Bjartell, Anders; Björholt, Ingela; Carlsson, Stefan; Hugosson, Jonas; Marlow, Thomas; Stinesen-Kollberg, Karin; Stranne, Johan; Wallerstedt, Anna; Wiklund, Peter; Wilderäng, Ulrica; Haglind, Eva

doi:10.1016/j.eururo.2018.07.038

Cited by 70 publications

(55 citation statements)

References 19 publications

(21 reference statements)

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“…Taken together, the question remains why RARP is disseminating so rapidly despite the lack of superiority for the most important quality markers along with its higher costs compared to ORP . We strongly believe that the introduction of the robotic approach has fuelled the building of high‐volume centres in which the proven advantages of high caseload are further delivered .…”

Section: Discussionmentioning

confidence: 99%

A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

et al. 2019

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ObjectiveTo compare oncological, functional and surgical outcomes of open retropubic radical prostatectomy (ORP) vs robotassisted laparoscopic radical prostatectomy (RARP). Patients and methodsWe identified 10 790 consecutive treated patients within our prospective database (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) who underwent either ORP (7007 patients) or RARP (3783). All procedures were performed by seven highly trained surgeons performing both surgical approaches regularly. Oncological (48-month biochemical recurrence [BCR] rate), functional (urinary continence, erectile function), and surgical outcomes (rate of nerve-sparing [NS] procedures, lymph node yield, surgical margin [SM] status, length of hospital stay [LOS], operation time, blood loss, transfusion rate, time to catheter removal) were assessed. Kaplan-Meier, multivariable Cox and logistic regression models were used to test for BCR and functional outcome differences. ResultsNo statistically significant difference regarding oncological outcome distinguished between ORP vs RARP. For functional outcomes, the 1-week continence rates were higher in the ORP group (25.8% vs 21.8%, P < 0.001). At 3 months, no statistically significant differences were observed. At 12 months, continence rates were modestly higher in the RARP group (90.3% vs 88.8%, P = 0.01). This effect was no longer observed after stratification for agegroups. The 12-month potency rates were similar in ORP vs RARP (80.3% vs 83.6%, P = 0.33). For surgical outcomes, there was no significant difference in the rates of NS procedures, lymph node yield, SM status, and LOS. Conversely, operation time was shorter in ORP, and blood loss, transfusion rates and time to catheter removal were significantly lower in RARP. ConclusionsBoth surgical approaches, performed in a high-volume centre by the same surgeons, achieve excellent, comparable oncological and functional outcomes. However, a modest advantage for RARP for surgical outcomes was observed, most likely attributable to its minimally invasive nature, and better teaching capabilities. Consequently, more than the surgical approach itself, the well-trained surgeon remains the most important factor to achieve satisfactory outcomes.

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Section: Discussionmentioning

confidence: 99%

A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

et al. 2019

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“…Productivity loss plays a key role in indirect costs. In prostate cancer the costs for sick leave following robotic surgery seemed to counterbalance the costs for the robotic procedure (Forsmark, et al 2018). The societal costs for sick leave, as well as informal care, with low costs in both groups in our trial, have not previously been studied in cost-analyses in gynaecological cancer surgery.…”

Section: Cost-effectiveness and Qalymentioning

confidence: 74%

On Quality Improvement in Gynaecological Cancer Surgery

Lundin

2020

Linköping University Medical Dissertations

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Objectives: The overall purpose of this thesis was to find medical and surgical treatment methods of improving the perioperative care of gynaecological cancer patients. The specific objectives were to determine whether a single dose tranexamic acid given immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and the need for blood transfusions, and to determine whether postoperative recovery, tissue damage, and inflammatory response markers differ between women operated with robotic and abdominal hysterectomy for low-risk endometrial cancer in an enhanced recovery after surgery (ERAS) programme, and to evaluate costs for hospital stay and postoperative recovery in relation to health impact. Material and Methods: The thesis was based on two randomised trials. The first trial was a randomised double-blind placebo-controlled multicentre study conducted in four hospitals in the southeast and central of Sweden between March 2008 and May 2012. One hundred women with presumed advanced ovarian cancer who had been scheduled for radical debulking surgery were included; 50 received tranexamic acid and 50 received a placebo. The main outcomes were blood loss and red blood cell transfusions. The second trial was a randomised open single centre trial at a Swedish university hospital, which included 50 women with low-risk endometrial cancer scheduled for radical surgery between February 2012 and May 2016; 25 women underwent robotic hysterectomy and 25 had abdominal hysterectomy. Anaesthesia and perioperative care followed an ERAS protocol in both groups. The EuroQol Group form EQ-5D-3L and the Short Form-36 evaluated the health-related quality of life. The Swedish Postoperative Symptoms Questionnaire assessed symptoms perioperatively until six weeks postoperatively. Venous blood samples were collected on several occasions until six weeks postoperatively and were analysed for markers reflecting inflammatory response and tissue damage. In addition, a health-economy analysis was conducted comparing total costs, quality-adjusted life years (QALYs) and cost per QALY between the surgical methods. Results: Total blood loss volume and transfusion rate following surgery in advanced ovarian cancer were significantly lower in the tranexamic group compared with the placebo group. Women with early endometrial cancer treated by robotic hysterectomy recovered significantly faster in the EQ-5D health index, and reached their preoperative level nearly two weeks earlier than the abdominal group. Differences regarding improvement in health-related quality of life (Short Form-36) comprising general health and social functioning were more favourable in the robotic hysterectomy group. Consumption of analgesics, pain intensity, postoperative symptom sum score and length of hospital stay were equal between the groups. The occurrence of complications was an independent risk factor and influenced most of the outcome measures adversely. Postoperative inflammatory response and tissue damage were lower after roboti...

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“…Операционный травматизм при РАРП, несомненно, меньше, чем у открытого вмешательства. Это связано со значительно более быстрой активизацией пациентов в послеоперационном периоде и более коротким временем выздоровления, что приводит к статистически значимому снижению срока пребывания в стационаре после РАРП [47,48]. Наряду с улучшением интракорпоральной визуализации за счет 16-кратного оптического увеличения в сочетании с более коротким периодом перед удалением уретрального катетера выполнение РАРП способствует раннему началу упражнений по укреплению тазового дна, что уменьшает послеоперационное недержание мочи, уменьшает потребность в послеоперационных обезболивающих средствах.…”

Section: сравнение интраоперационных параметров открытой и роботизироunclassified

Radical Prostatectomy: from Open Surgery towards Robotic Laparoscopy

Виланд

Burger

Denzinger

et al. 2020

Kreativnaâ hirurgiâ i onkologiâ

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Radical prostatectomy was first performed more than 100 years ago and has since become the gold standard in treatment of localized prostate cancer. Open surgery has been almost entirely replaced by robotic operations referred to as robot-assisted radical prostatectomy (RARP). Th e article introduces the basics of this innovative standard of operative access and tackles medical and historical aspects, oncological, medical and economic management pros and contras of robotic aid over open radical prostatectomy. Surgical trauma in RARP is clearly less pronounced compared to open surgery due to a much earlier postoperative mobilisation and a faster rehabilitation of patients leading to a statistically significant reduction in the length of hospital stay after RARP. Along with advances in intracorporeal imaging with 16-fold optical magnification coupled with shorter urethral catheterisation, RARP facilitates an earlier start of pelvic floor exercises, which reduces postoperative incontinence and need for pain relievers. Th e already mentioned technical advantages of the robotic method hold value to both patient and surgeon by securing instant access for an experienced colleague without interrupting the surgery. Noteworthy, the increasing advancement of robotic systems across the globe is leading urologist surgeons to abandon open operations. A drawback of the robotic method is much higher economic costs. However, greater expenditures may pay off in the long run by shorter hospital stays, faster rehabilitation and fewer complications demanding extra management and care.

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Health Economic Analysis of Open and Robot-assisted Laparoscopic Surgery for Prostate Cancer Within the Prospective Multicentre LAPPRO Trial

Abstract: In this study, we looked at the cost outcome when performing prostatectomies by robot-assisted laparoscopic technique compared with open surgery in Sweden. We found that the robot-assisted procedure was associated with a higher mean cost.

Cited by 70 publications

References 19 publications

A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

A comparative study of robot‐assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

On Quality Improvement in Gynaecological Cancer Surgery

Radical Prostatectomy: from Open Surgery towards Robotic Laparoscopy

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