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Comparative Study
. 2022 Jan;207(1):127-136.
doi: 10.1097/JU.0000000000002176. Epub 2021 Aug 26.

Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 Consortium

Peter Chang  1 , Andrew A Wagner  1 , Meredith M Regan  2 , Joseph A Smith  3 , Christopher S Saigal  4 , Mark S Litwin  4   5 , Jim C Hu  6 , Matthew R Cooperberg  7 , Peter R Carroll  7 , Eric A Klein  8 , Adam S Kibel  9 , Gerald L Andriole  10 , Misop Han  11 , Alan W Partin  11 , David P Wood  12 , Catrina M Crociani  1 , Thomas K Greenfield  13 , Dattatraya Patil  14 , Larry A Hembroff  15 , Kyle Davis  15 , Linda Stork  15 , Daniel E Spratt  16 , John T Wei  17 , Martin G Sanda  14 ; PROST-QA/RP2 Consortium
Affiliations
Comparative Study

Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 Consortium

Peter Chang et al. J Urol. 2022 Jan.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01325506.

Keywords: prostatectomy; quality of life; robotic surgical procedures.

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Conflict of interest statement

Conflicts of Interest/Disclosures:

Peter Chang: none

Andrew Wagner: none

Meredith Regan: none

Joseph Smith: none

Christopher Saigal: none

Mark Litwin: none

Jim Hu: supported by “The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust”, PCORI CER-2019C1–15682, PCORI CER-2019C2–17372, and NCI RO1 CA241758.

Matthew Cooperberg: none

Peter Carroll: none

Eric Klein: none

Adam Kibel consults for Dendreon and Sanofi.

Gerald Andriole: none

Misop Han: none

Alan Partin: none

David Wood: none

Catrina Crociani: none

Thomas Greenfield: none

Dattatraya Patil: none

Larry Hembroff: none

Kyle Davis: none

Linda Stork: none

Daniel Spratt: none

John Wei: none

Martin Sanda: none

Figures

Figure 1
Figure 1. CONSORT Diagram
ORP = Open radical prostatectomy RALP = Robot-assisted laparoscopic prostatectomy
Figure 2
Figure 2. Longitudinal patient-reported HRQOL and satisfaction with cancer outcome after radical prostatectomy, stratified by surgical approach and nerve-sparing status
ORP = Open radical prostatectomy RALP = Robot-assisted laparoscopic prostatectomy Panels A-E are health domains of the EPIC-26 HRQOL instrument Panel F describes satisfaction with cancer outcome, a domain of the Service Satisfaction Scale for Cancer Care (SCA) instrument Surgical approach (ORP vs RALP) was not found to be a significant predictor of longitudinal patient-reported HRQOL change in any domain.
See this image and copyright information in PMC

References

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