Comparison of Perioperative and Early Oncologic Outcomes between Open and Robotic Assisted Laparoscopic Prostatectomy in a Contemporary Population Based Cohort

Shane M. Pearce, Joseph J Pariser, Theodore Karrison, Sanjay G. Patel, Scott E. Eggener

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose We compared rates of positive surgical margins, use of postoperative radiation therapy, and perioperative outcomes between robotic assisted laparoscopic and open radical prostatectomy in a contemporary population based cohort. Materials and Methods In the National Cancer Data Base from 2010 through 2011 patients who underwent robotic assisted laparoscopic prostatectomy (73,131) and open radical prostatectomy (23,804) for nonmetastatic prostate adenocarcinoma were identified. Covariates included age, race, Charlson comorbidity index, prostate specific antigen, biopsy Gleason score, clinical stage, final Gleason score, pathological T stage, lymph node dissection, nodal status, facility type, hospital volume and year of surgery. Multivariable logistic regression was used to identify factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission and 30-day mortality. Outcomes were also compared in 1:1 propensity matched cohorts. Results Analysis of propensity matched cohorts showed robotic assisted laparoscopic prostatectomy reduced the risk of positive surgical margins (OR 0.88, 95% CI 0.83–0.93, p <0.01), the use of radiation therapy (OR 0.71, 95% CI 0.63–0.80, p <0.01) and 30-day mortality (OR 0.28, 95% CI 0.13–0.60, p <0.01). The protective effect of robotic assisted laparoscopic prostatectomy for positive surgical margins was found in patients with pT2 disease only (pT2—OR 0.85, 95% CI 0.79–0.91, p <0.01; pT3—OR 0.94, 95% CI 0.86–1.04, p=0.2). Similar results were obtained using multivariable regression. Conclusions In a contemporary large national cohort, robotic assisted laparoscopic prostatectomy was independently associated with clinically meaningful reductions in positive surgical margins, postoperative radiation therapy and 30-day mortality compared to open radical prostatectomy. The oncologic benefit was primarily in patients with organ confined disease. Limitations were those associated with any observational study, namely the potential for bias due to unmeasured confounders.

Original languageEnglish (US)
Pages (from-to)76-81
Number of pages6
JournalJournal of Urology
Volume196
Issue number1
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Fingerprint

Robotics
Prostatectomy
Population
Radiotherapy
Neoplasm Grading
Mortality
Salvage Therapy
Prostate-Specific Antigen
Lymph Node Excision
Observational Studies
Comorbidity
Prostate
Length of Stay
Adenocarcinoma
Logistic Models
Margins of Excision
Databases
Biopsy
Neoplasms

Keywords

  • mortality
  • prostatectomy
  • prostatic neoplasms
  • robotics
  • treatment outcome

Cite this

Comparison of Perioperative and Early Oncologic Outcomes between Open and Robotic Assisted Laparoscopic Prostatectomy in a Contemporary Population Based Cohort. / Pearce, Shane M.; Pariser, Joseph J; Karrison, Theodore; Patel, Sanjay G.; Eggener, Scott E.

In: Journal of Urology, Vol. 196, No. 1, 01.07.2016, p. 76-81.

Research output: Contribution to journalArticle

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abstract = "Purpose We compared rates of positive surgical margins, use of postoperative radiation therapy, and perioperative outcomes between robotic assisted laparoscopic and open radical prostatectomy in a contemporary population based cohort. Materials and Methods In the National Cancer Data Base from 2010 through 2011 patients who underwent robotic assisted laparoscopic prostatectomy (73,131) and open radical prostatectomy (23,804) for nonmetastatic prostate adenocarcinoma were identified. Covariates included age, race, Charlson comorbidity index, prostate specific antigen, biopsy Gleason score, clinical stage, final Gleason score, pathological T stage, lymph node dissection, nodal status, facility type, hospital volume and year of surgery. Multivariable logistic regression was used to identify factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission and 30-day mortality. Outcomes were also compared in 1:1 propensity matched cohorts. Results Analysis of propensity matched cohorts showed robotic assisted laparoscopic prostatectomy reduced the risk of positive surgical margins (OR 0.88, 95{\%} CI 0.83–0.93, p <0.01), the use of radiation therapy (OR 0.71, 95{\%} CI 0.63–0.80, p <0.01) and 30-day mortality (OR 0.28, 95{\%} CI 0.13–0.60, p <0.01). The protective effect of robotic assisted laparoscopic prostatectomy for positive surgical margins was found in patients with pT2 disease only (pT2—OR 0.85, 95{\%} CI 0.79–0.91, p <0.01; pT3—OR 0.94, 95{\%} CI 0.86–1.04, p=0.2). Similar results were obtained using multivariable regression. Conclusions In a contemporary large national cohort, robotic assisted laparoscopic prostatectomy was independently associated with clinically meaningful reductions in positive surgical margins, postoperative radiation therapy and 30-day mortality compared to open radical prostatectomy. The oncologic benefit was primarily in patients with organ confined disease. Limitations were those associated with any observational study, namely the potential for bias due to unmeasured confounders.",
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T1 - Comparison of Perioperative and Early Oncologic Outcomes between Open and Robotic Assisted Laparoscopic Prostatectomy in a Contemporary Population Based Cohort

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AU - Pariser, Joseph J

AU - Karrison, Theodore

AU - Patel, Sanjay G.

AU - Eggener, Scott E.

PY - 2016/7/1

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N2 - Purpose We compared rates of positive surgical margins, use of postoperative radiation therapy, and perioperative outcomes between robotic assisted laparoscopic and open radical prostatectomy in a contemporary population based cohort. Materials and Methods In the National Cancer Data Base from 2010 through 2011 patients who underwent robotic assisted laparoscopic prostatectomy (73,131) and open radical prostatectomy (23,804) for nonmetastatic prostate adenocarcinoma were identified. Covariates included age, race, Charlson comorbidity index, prostate specific antigen, biopsy Gleason score, clinical stage, final Gleason score, pathological T stage, lymph node dissection, nodal status, facility type, hospital volume and year of surgery. Multivariable logistic regression was used to identify factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission and 30-day mortality. Outcomes were also compared in 1:1 propensity matched cohorts. Results Analysis of propensity matched cohorts showed robotic assisted laparoscopic prostatectomy reduced the risk of positive surgical margins (OR 0.88, 95% CI 0.83–0.93, p <0.01), the use of radiation therapy (OR 0.71, 95% CI 0.63–0.80, p <0.01) and 30-day mortality (OR 0.28, 95% CI 0.13–0.60, p <0.01). The protective effect of robotic assisted laparoscopic prostatectomy for positive surgical margins was found in patients with pT2 disease only (pT2—OR 0.85, 95% CI 0.79–0.91, p <0.01; pT3—OR 0.94, 95% CI 0.86–1.04, p=0.2). Similar results were obtained using multivariable regression. Conclusions In a contemporary large national cohort, robotic assisted laparoscopic prostatectomy was independently associated with clinically meaningful reductions in positive surgical margins, postoperative radiation therapy and 30-day mortality compared to open radical prostatectomy. The oncologic benefit was primarily in patients with organ confined disease. Limitations were those associated with any observational study, namely the potential for bias due to unmeasured confounders.

AB - Purpose We compared rates of positive surgical margins, use of postoperative radiation therapy, and perioperative outcomes between robotic assisted laparoscopic and open radical prostatectomy in a contemporary population based cohort. Materials and Methods In the National Cancer Data Base from 2010 through 2011 patients who underwent robotic assisted laparoscopic prostatectomy (73,131) and open radical prostatectomy (23,804) for nonmetastatic prostate adenocarcinoma were identified. Covariates included age, race, Charlson comorbidity index, prostate specific antigen, biopsy Gleason score, clinical stage, final Gleason score, pathological T stage, lymph node dissection, nodal status, facility type, hospital volume and year of surgery. Multivariable logistic regression was used to identify factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission and 30-day mortality. Outcomes were also compared in 1:1 propensity matched cohorts. Results Analysis of propensity matched cohorts showed robotic assisted laparoscopic prostatectomy reduced the risk of positive surgical margins (OR 0.88, 95% CI 0.83–0.93, p <0.01), the use of radiation therapy (OR 0.71, 95% CI 0.63–0.80, p <0.01) and 30-day mortality (OR 0.28, 95% CI 0.13–0.60, p <0.01). The protective effect of robotic assisted laparoscopic prostatectomy for positive surgical margins was found in patients with pT2 disease only (pT2—OR 0.85, 95% CI 0.79–0.91, p <0.01; pT3—OR 0.94, 95% CI 0.86–1.04, p=0.2). Similar results were obtained using multivariable regression. Conclusions In a contemporary large national cohort, robotic assisted laparoscopic prostatectomy was independently associated with clinically meaningful reductions in positive surgical margins, postoperative radiation therapy and 30-day mortality compared to open radical prostatectomy. The oncologic benefit was primarily in patients with organ confined disease. Limitations were those associated with any observational study, namely the potential for bias due to unmeasured confounders.

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