Authors: Gandaglia G, Abdollah F, Hu J, Kim S, Briganti A, Sammon JD, Becker A, Roghmann F, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI, Trinh QD, Sun M
Title: Is Robot-Assisted Radical Prostatectomy Safe in Men with High-Risk Prostate Cancer? Assessment of Perioperative Outcomes, Positive Surgical Margins, and Use of Additional Cancer Treatments.
Journal: J Endourol :-
Date: 2014 Feb 05
Abstract: Introduction: Despite a rapid dissemination of robot-assisted radical prostatectomy (RARP) over open RP (ORP), to date no study compared perioperative outcomes between the two approaches in patients with high-risk prostate cancer (PCa). The aim of our study was to evaluate the safety and feasibility of RARP in this setting. Patients and Methods: Overall, 1,512 patients with high-risk PCa within the Surveillance Epidemiology and End Results (SEER) Medicare-linked database diagnosed between 2008 and 2009 were abstracted. Patients were treated with RARP or ORP. Postoperative complications, blood transfusions, prolonged length of hospital stay (pLOS), positive surgical margins, and additional cancer therapy rates were compared. Propensity-score matched analyses and logistic regression models fitted with generalized estimating equations for clustering among hospitals were performed. Results: Overall, 706 (46.7%) and 806 (53.3%) patients underwent ORP and RARP, respectively. Following propensity-matched analyses, 706 patients remained. No differences were observed in complications (P=0.6), positive surgical margins (P=0.4), and additional therapy after surgery (P=0.2) between patients treated with RARP and ORP. However, RARP was associated with lower rates of transfusions and shorter hospitalization (all P<0.001). In multivariable analyses, patients undergoing RARP were less likely to receive a blood transfusion (P=0.002) and to experience a pLOS (P<0.001) compared to men treated with ORP. Conclusions: RARP and ORP have comparable complications, positive surgical margins, and additional cancer therapy rates in high-risk PCa. RARP is associated with lower rates of blood transfusions and shorter LOS. These findings suggest that RARP is safe and feasible even in this clinical scenario.
Last Modified: 03 Sep 2013