Quality of Evidence to Compare Outcomes of Open and Robot-Assisted Laparoscopic Prostatectomy

Duffey, Branden G.; Varda, Briony K.; Konety, Badrinath R.

doi:10.1007/s11934-011-0180-6

Cited by 16 publications

(11 citation statements)

References 41 publications

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“…This increase has taken place despite a paucity of high-quality data supporting the benefits of robot-assisted laparoscopic radical prostatectomy (RALP) over open retropubic radical prostatectomy (RRP) [2–4]. Evaluation of clinical data on perioperative outcomes of RALP and RRP are generally limited to single-institution case series in which RALP was associated with lower estimated blood loss (EBL), shorter lengths of hospital stay (LOS), lower or similar rates of positive surgical margins (PSMs), and no difference in biochemical recurrence–free survival (bRFS) [2,5,6]. The only population-based studies are restricted to claims-based data [7–9], with concerns about incomplete reporting and accuracy of data.…”

Section: Introductionmentioning

confidence: 99%

Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study

et al. 2015

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Background Robot-assisted laparoscopic radical prostatectomy (RALP) has become increasingly common; however, there have been no nationwide, population-based, non–claims-based studies to evaluate differences in outcomes between RALP and open radical retropubic prostatectomy (RRP). Objective To determine surgical, oncologic, and health-related quality of life (HRQOL) outcomes following RALP and RRP in a nationwide cohort. Design, setting, and participants We identified 903 men in the Health Professionals Follow-up Study diagnosed with prostate cancer between 2000 and 2010 who underwent radical prostatectomy using RALP (n = 282) or RRP (n = 621) as primary treatment. Intervention Radical prostatectomy. Outcome measurements and statistical analysis We compared patients undergoing RALP or RRP across a range of perioperative, oncologic, and HRQOL outcomes. Results and limitations Use of RALP increased during the study period, constituting 85.2% of study subjects in 2009, up from 4.5% in 2003. Patients undergoing RALP compared to RRP were less likely to have a lymph node dissection (51.5% vs 85.4%; p < 0.0001), had less blood loss (207.4 ml vs 852.3 ml; p < 0.0001), were less likely to receive blood transfusions (4.3% vs 30.3%; p < 0.0001), and had shorter hospital stays (1.8 d vs 2.9 d; p < 0.0001). Surgical, oncologic, and HRQOL outcomes did not differ significantly among the groups. In multivariate logistic regression models, there were no significant differences in 3- or 5-yr recurrence-free survival comparing RALP versus RRP (hazard ratios: 0.98 [95% confidence interval (CI), 0.46–2.08] and 0.75 [95% CI, 0.18–3.11], respectively). Conclusions In a nationwide cohort of patients undergoing surgical treatment for prostate cancer, RALP was associated with shorter hospital stay, and lower blood loss and transfusion rates than RRP. Surgical oncologic and HRQOL outcomes were similar between groups. Patient summary We studied men throughout the United States with prostate cancer who underwent surgical removal of the prostate. We found that robot-assisted laparoscopic radical prostatectomy resulted in shorter hospital stay, less blood loss, and fewer blood transfusions than radical retropubic prostatectomy. There were no differences in cancer control or health-related quality of life.

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Section: Introductionmentioning

confidence: 99%

Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study

et al. 2015

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“…A growing body of literature has reported the superiority of robotic surgery as compared with traditional surgery [20][21][22][23]. On this foundation, our study would further explain the advantages of RARP for treating clinically localized PCa vs. ORP.…”

Section: Discussionmentioning

confidence: 64%

Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis

et al. 2014

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Open retropubic radical prostatectomy (ORP) remains the "gold standard" for surgical treatment of clinically localized prostate cancer (PCa). Robot-assisted radical prostatectomy (RARP) is a robotic surgery used worldwide. The aim of this study is to collect the data available in the literature on RARP and ORP, and further evaluate the overall safety and efficacy of RARP vs. ORP for the treatment of clinically localized PCa. A literature search was performed using electronic databases between January 2009 and October 2013. Clinical data such as operation duration, transfusion rate, positive surgical margins (PSM), nerve sparing, 3-and 12-month urinary continence, and potency were pooled to carry out metaanalysis. Six studies were enrolled for this meta-analysis. The operation duration of RARP group was longer than that of ORP group (weighted mean difference=64.84). There was no statistically significant difference in the transfusion rate, PSM rate, and between RARP and ORP (transfusion rate, OR=0.30; PSM rate, OR=0.94). No significant difference was seen in 3-and 12-month urinary continence recovery (3 months, OR= 1.32; 12 months, OR=1.30). There was a statistically significant difference in potency between the 3-and 12-month groups (3 months, OR=2.80; 12 months, OR=1.70). RARP is a safe and feasible surgical technique for the treatment of clinically localized PCa owing to the advantages of fewer perioperative complications and quicker patency recovery.Keywords Robot-assisted radical prostatectomy . Open retropubic radical prostatectomy . Prostate cancer Abbreviations PCaProstate cancer RP Radical prostatectomy ORP Open retropubic radical prostatectomy RRP Retropubic radical prostatectomy RARP Robot-assisted radical prostatectomy RALP Robot-assisted laparoscopic prostatectomy PSA Prostate-specific antigen NOS Newcastle-Ottawa Scale Xiu-wu Pan and Xin-ming Cui contributed equally to this work.

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“…[13] Robotic surgery is expected to enable better cancer control and better post-operative quality-of-life (QOL) than other modalities partly due to the higher costs of robotic surgeries than open or laparoscopic surgeries. [14] Two of the most important aspects of QOL are urinary continence and erectile function[15] and these are expected to be improved using delicate techniques such as NS procedures. [16]…”

Section: Discussionmentioning

confidence: 99%

Histological evaluation of nerve sparing technique in robotic assisted radical prostatectomy

et al. 2014

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Introduction:The objective of this study is to compare intrafascial nerve-sparing (NS), interfascial NS and non-NS prostatecomy specimens to assess the feasibility of NS technique in Robot-assisted radical prostatectomies (RARP).Materials and Methods:The records of the first 43 consecutive patients (86 prostatic sides (lobe) who underwent NS RARP (6 intrafascial NS, 46 interfacial NS, 34 non-NS) were reviewed and histopathological examinations were performed. The presence and distribution of periprostatic neurovascular structures were histologically evaluated using mid-gland section of each prostate lobe in the prostatectomy specimen and it was immunostained with the S-100 antibody for quantitative analysis of nerves.Results:The average number of nerve fibers per prostatic half was 37.2 ± 20.6. The number of resected peri-prostatic nerves counted was 13.7 ± 13.5, 30.5 ± 15.0 and 50.4 ± 20.4 in intrafascial NS, interfascial NS and non-NS specimens, respectively. The difference in the number of nerve bundle counts in the three groups was statistically significant (P < 0.05). Patients with urinary continence at 6 months after surgery had significantly less number of nerve fibers resected with the prostate than the incontinence group (P = 0.013) and the number of nerve fibers resected in the potent group were lower than in the impotent group but did not reach statistical significance (P = 0.057).Conclusions:Our study showed that NS RARP could be performed according to surgeons’ intention (intrafascial, interfascial or non-NS) and urinary continence significantly correlated to the number of nerve fibers resected with the prostate.

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Quality of Evidence to Compare Outcomes of Open and Robot-Assisted Laparoscopic Prostatectomy

Cited by 16 publications

References 41 publications

Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study

Benchmarks for Operative Outcomes of Robotic and Open Radical Prostatectomy: Results from the Health Professionals Follow-up Study

Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis

Histological evaluation of nerve sparing technique in robotic assisted radical prostatectomy

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