Sunday June 30, 2019 from 07:30 to 09:00
Prospective comparison of open and robot-assisted radical prostatectomy for clinically localized prostate cancer in the Canadian healthcare system
Benjamin Beech1, Jan K. Rudzinski1, Ryan McLarty1, Sunita Ghosh2, Graeme Follett1, Adrian Fairey1.
1Department of Surgery, Division of Urology, University of Alberta, Edmonton, AB, Canada; 2Department of Oncology, University of Alberta, Edmonton, AB, Canada
Introduction: High-quality data comparing open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) are sparse. We compared pathological cancer control and perioperative outcomes in men with clinically localized prostate cancer (CLPC).
Methods: The study was a prospective, comparative analysis. Eligible subjects had newly diagnosed CLPC and had chosen radical prostatectomy as their primary treatment. Subjects were allocated to either ORP (two surgeons) or RARP (seven surgeons) based on surgeon practice. The outcomes were positive surgical margins (R1), estimated blood loss (EBL), blood transfusion, serious adverse event (SAE; ≥ Clavien 3a), 90-day mortality, 90-day return to the emergency room, and length of hospital stay (LOS). T-tests and Chi-square tests were used to analyze outcomes (two-sided p<0.05).
Results: Between September 2007 and May 2018, 3152 men were practice-allocated to ORP (n=331) or RARP (n=2821). Baseline characteristics did not differ between groups except that a lower proportion of men had National Comprehensive Cancer Network intermediate-risk disease in the ORP group (49% vs. 62%; p<0.01). R1 (24.2% vs. 24.8%; p=0.81), SAE (1.8% vs. 2.2%; p=0.65), 90-day mortality (0.3% vs. 0.1%; p=0.35), and 90-day return to the emergency room (20.0% vs. 23.5%; p=0.14) did not differ between the ORP and RARP groups. EBL (478 ml vs. 140 ml; p<0.01), blood transfusion (4.0% vs. 1.6%; p<0.01), and LOS (2.8 days vs. 2.4 days; p<0.01) were lower in the RARP group.
Conclusions: RARP was associated with lower EBL, blood transfusion, and LOS compared to ORP.