Robotic vs Open Prostatectomy Provides Early Benefits for pT2

Reduced risk of positive surgical margins versus open prostatectomy for patients with pT2 disease only.
Reduced risk of positive surgical margins versus open prostatectomy for patients with pT2 disease only.

(HealthDay News) -- Robotic-assisted laparoscopic prostatectomy is associated with reductions in positive surgical margins, postoperative radiation therapy, and 30-day mortality, according to a study published in The Journal of Urology.

Shane M. Pearce, MD, from the University of Chicago Medicine and Biological Sciences, and colleagues compared outcomes for patients who underwent robotic-assisted laparoscopic prostatectomy (73,131 patients) and open radical prostatectomy (23,804 patients) for nonmetastatic prostate adenocarcinoma. The authors examined factors associated with positive surgical margins, use of adjuvant/salvage radiation therapy, prolonged length of stay, readmission, and 30-day mortality. Outcomes were compared in propensity matched cohorts.

The researcher found that propensity-matched cohort analysis showed a reduced risk of positive surgical margins, use of radiation therapy, and 30-day mortality with robotic-assisted laparoscopic prostatectomy (odds ratios, 0.88, 0.71, and 0.28, respectively; all P < .001). The protective effect on positive surgical margins was only seen for patients with pT2 disease (pT2: odds ratio, 0.85; 95% confidence interval, 0.79 to 0.91; pT3: odds ratio, 0.94; 95 percent confidence interval, 0.86 to 1.04).

"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 authors write. "The oncologic benefit was primarily in patients with organ confined disease."

Sources

1. Pearce SM, Pariser JJ, Karrison T, Patel SG, and Eggener SE. Comparison of Perioperative and Early Oncologic Outcomes between Open and Robotic Assisted Laparoscopic Prostatectomy in a Contemporary Population Based Cohort. J Urol. doi: 10.1016/j.juro.2016.01.105.

2. Koch MO. Robotic versus Open Prostatectomy: End of the Controversy. J Urol. doi: 10.1016/j.juro.2016.04.047.

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