- Chang, Peter;
- Wagner, Andrew A;
- Regan, Meredith M;
- Smith, Joseph A;
- Saigal, Christopher S;
- Litwin, Mark S;
- Hu, Jim C;
- Cooperberg, Matthew R;
- Carroll, Peter R;
- Klein, Eric A;
- Kibel, Adam S;
- Andriole, Gerald L;
- Han, Misop;
- Partin, Alan W;
- Wood, David P;
- Crociani, Catrina M;
- Greenfield, Thomas K;
- Patil, Dattatraya;
- Hembroff, Larry A;
- Davis, Kyle;
- Stork, Linda;
- Spratt, Daniel E;
- Wei, John T;
- Sanda, Martin G;
- Consortium, and the PROST-QA RP2
Purpose
Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study.Materials and methods
We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications.Results
Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain.Conclusions
In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.