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Nationwide Comparison of Operative Outcomes for Robotic, Laparoscopic, and Open Radical Prostatectomy
Mehrdad Alemozaffar1, Martin G Sanda1, Derek Yecies2, Meir J Stampfer3, Stacey A Kenfield3
1Beth Israel Deaconess Medical Center, Boston, MA;2Boston University Medical School, Boston, MA;3Harvard School of Public Health, Boston, MA
Introduction:
Multi-center, community-based evaluations of robot-assisted laparosopic prostatectomy (RALP) and radical retropubic prostatectomy (RRP) are lacking. We sought to evaluate perioperative and oncologic outcomes of RALP and RRP for prostate cancer in a nationwide cohort.
Methods:
The Health Professionals Follow-up Study (HPFS) cohort of 51,529 men was interrogated to evaluate outcomes of men who underwent RALP (N=172) and RRP (N=573) from 2000 to 2009.
Results:
Tumor severity was slightly greater among RRP than RALP patients (Table 1). RRP patients were more likely than RALP to undergo lymphadenectomy (85.4% vs. 46.5%, respectively, p<0.0001), experienced greater mean estimated blood loss (858.9 vs. 206.0 ml, respectively, p<0.0001), were more likely to receive blood transfusions (26.3% vs. 4.7%, respectively, p<0.0001), and had longer mean hospital stays (2.9 vs. 1.9 days, p=0.0001) (Table 2). Oncologic outcomes between RRP and RALP revealed no difference in pathologic stage, gleason score, positive surgical margins, or psa-specific survival (Table 3).
Conclusions:
In this nationwide, community-based cohort RALP was associated with shorter hospital stay and less blood loss than RRP, while yielding similar oncologic outcomes.
Table 1. Preoperative Tumor Characteristics | | Total
(N = 745) | RALP
(N = 172) | RRP
(N = 573) | P - Value | | Clinical T-Stage | T1 | 68.9 | 77.3 | 66.5 | 0.01 (T1 vs T2+) | | T2 | 31.0 | 22.7 | 33.3 | | | T3 | 0.1 | 0 | 0.2 | | | T4 | 0 | 0 | 0 | | | PSA | Median (ng/dl) | 5.5 | 5.2 | 5.7 | 0.04 | | Biopsy Gleason Score | <6 | 3.5 | 1.2 | 4.2 | 0.04 | | 6 | 59.1 | 55.9 | 60.1 | | | 7 | 29.9 | 37.1 | 27.8 | | | 8+ | 7.4 | 5.9 | 7.9 | |
Table 3. Oncologic Outcomes | | Total
(N = 745) | RALP
(N = 172) | RRP
(N = 573) | P - Value | Pathologic
T-Stage | T2 | 79.3 | 79.3 | 79.3 | 1.0 | | T3 | 20.6 | 20.7 | 20.6 | | | T4 | 0.14 | 0 | 0.2 | | | Gleason Score | < or =6 | 45.2 | 37.1 | 47.6 | 0.07 | | 7 | 46.5 | 55.7 | 43.9 | | | 8 | 3.9 | 3.6 | 4.0 | | | 9+ | 4.3 | 3.6 | 4.6 | | | Positive Margins | % Patients | 23.1 | 26.1 | 23.1 | 0.47 | | Extracapsular Extension | % Patients | 23.1 | 19.8 | 24.1 | 0.29 |
Table 2. Perioperative Outcomes | | Total
(N = 745) | RALP
(N = 172) | RRP
(N = 573) | P - Value | | Nerve-Sparing | Bilateral | 69.4 | 71.6 | 68.8 | 0.82 | | Unilateral | 14.7 | 14.2 | 14.8 | | | None | 15.9 | 14.2 | 16.4 | | | Seminal Vesicle Removal | % Patients | 97.1 | 97.6 | 97.0 | | | Lymph Node Dissection | % Patients | 77.0 | 47.0 | 85.6 | <0.0001 | | Hospital Stay | Mean (days) | 2.7 | 1.9 | 2.9 | 0.0001 | | EBL | Mean (cc) | 712.8 | 206.0 | 858.9 | <0.0001 | | Transfusions | % Patients | 26.3 | 4.7 | 30.4 | <0.0001 | | Mean Units | 2.0 | 2.8 | 2.0 | 0.54 |
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