Document Detail


A case-mix-adjusted comparison of early oncological outcomes of open and robotic prostatectomy performed by experienced high volume surgeons.
MedLine Citation:
PMID:  23356747     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare early oncological outcomes of robot assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) performed by high volume surgeons in a contemporary cohort.
METHODS: We reviewed patients who underwent radical prostatectomy for prostate cancer by high volume surgeons performing RALP or ORP. Biochemical recurrence (BCR) was defined as PSA ≥ 0.1 ng/mL or PSA ≥ 0.05 ng/mL with receipt of additional therapy. A Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (nomogram) based on preoperative stage, grade, volume of disease and PSA. To explore the impact of differences between surgeons, multivariable analyses were repeated using surgeon in place of approach.
RESULTS: Of 1454 patients included, 961 (66%) underwent ORP and 493 (34%) RALP and there were no important differences in cancer characteristics by group. Overall, 68% of patients met National Comprehensive Cancer Network (NCCN) criteria for intermediate or high risk disease and 9% had lymph node involvement. Positive margin rates were 15% for both open and robotic groups. In a multivariate model adjusting for preoperative risk there was no significant difference in BCR rates for RALP compared with ORP (hazard ratio 0.88; 95% CI 0.56-1.39; P = 0.6). The interaction term between nomogram risk and procedure type was not statistically significant. Using NCCN risk group as the covariate in a Cox model gave similar results (hazard ratio 0.74; 95% CI 0.47-1.17; P = 0.2). The interaction term between NCCN risk and procedure type was also non-significant. Differences in BCR rates between techniques (4.1% vs 3.3% adjusted risk at 2 years) were smaller than those between surgeons (2.5% to 4.8% adjusted risk at 2 years).
CONCLUSIONS: In this relatively high risk cohort of patients undergoing radical prostatectomy we found no evidence to suggest that ORP resulted in better early oncological outcomes then RALP. Oncological outcome after radical prostatectomy may be driven more by surgeon factors than surgical approach.
Authors:
Jonathan L Silberstein; Daniel Su; Leonard Glickman; Matthew Kent; Gal Keren-Paz; Andrew J Vickers; Jonathan A Coleman; James A Eastham; Peter T Scardino; Vincent P Laudone
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BJU international     Volume:  111     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-29     Completed Date:  2013-03-20     Revised Date:  2014-06-26    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  206-12     Citation Subset:  IM    
Copyright Information:
© 2013 The Authors BJU International © 2013 BJU International.
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MeSH Terms
Descriptor/Qualifier:
Aged
Clinical Competence / standards
Diagnosis-Related Groups
Epidemiologic Methods
Hospitals, High-Volume / statistics & numerical data
Humans
Laparoscopy / methods*,  mortality
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local / mortality*,  pathology
Prostate-Specific Antigen / blood
Prostatectomy / methods*,  mortality,  statistics & numerical data
Prostatic Neoplasms / mortality,  pathology,  surgery*
Robotics / methods*,  utilization
Treatment Outcome
Urology / standards*,  statistics & numerical data
Workload
Grant Support
ID/Acronym/Agency:
P30 CA008748/CA/NCI NIH HHS; P50 CA092629/CA/NCI NIH HHS; T32 CA082088/CA/NCI NIH HHS; T32 CA082088-12/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
EC 3.4.21.77/Prostate-Specific Antigen
Comments/Corrections
Comment In:
BJU Int. 2013 Feb;111(2):184-5   [PMID:  23356744 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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