Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era

Giorgio Gandaglia, Pierre I. Karakiewicz, Maxine Sun, Francesco Montorsi, Jesse D. Sammon, Mani Menon, Steven L. Chang, Toni K. Choueiri, Adam S. Kibel, Ramdev Konijeti, Paul L. Nguyen, Quoc Dien Trinh, Jim C. Hu, Simon P. Kim, Shyam Sukumar

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Given the lack of randomized trials comparing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we sought to re-examine the outcomes of these techniques using a cohort of patients treated in the postdissemination era. Patients and Methods: Overall, data from 5,915 patients with prostate cancer treated with RARP or ORP within the SEER-Medicare linked database diagnosed between October 2008 and December 2009 were abstracted. Postoperative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies, and costs of care within the first year after surgery were compared between the two surgical approaches. To decrease the effect of unmeasured confounders, instrumental variable analysis was performed. Multivariable logistic regression analyses were then performed. Results: Overall, 2,439 patients (41.2%) and 3,476 patients (58.8%) underwent ORP and RARP, respectively. In multivariable analyses, patients undergoing RARP had similar odds of overall complications, readmission, and additional cancer therapies compared with patients undergoing ORP. However, RARP was associated with a higher probability of experiencing 30- and 90-day genitourinary and miscellaneous medical complications (all P ≤ .02). Additionally, RARP led to a lower risk of experiencing blood transfusion and of having a pLOS (all P <.001). Finally, first-year reimbursements were greater for patients undergoing RARP compared with ORP (P <.001). Conclusion: RARP and ORP have comparable rates of complications and additional cancer therapies, even in the postdissemination era. Although RARP was associated with lower risk of blood transfusions and a slightly shorter length of stay, these benefits do not translate to a decrease in expenditures.

Original languageEnglish
Pages (from-to)1419-1426
Number of pages8
JournalJournal of Clinical Oncology
Volume32
Issue number14
DOIs
Publication statusPublished - May 10 2014

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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