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    RARP: ‘Little clear benefit’ compared to open surgery

    Post-op complication, readmission rates similar in population-based analysis

    Montreal—Robot-assisted radical prostatectomy (RARP) is associated with a lower rate of blood transfusion and shorter length of stay compared to open surgery. However, the total first-year reimbursement is higher for RARP and there is no difference between the two procedures in the rate of postoperative complications or use of additional cancer treatment, according to an analysis of contemporary data from the Surveillance, Epidemiology, and End Results Medicare-linked database.

    RELATED: Use of robotic RN rising, despite unclear advantages

    The study was presented at the AUA annual meeting in Orlando, FL and was recently published in the Journal of Clinical Oncology (2014; 32:1419-26). It included 5,915 men operated on between October 2008 and December 2009, of whom 41% underwent open radical prostatectomy and 59% had RARP.

    “RARP was rapidly adopted after its introduction and is currently the dominant technique for surgical treatment of localized prostate cancer in the U.S., accounting for more than 60% of radical prostatectomy procedures,” said first author Giorgio Gandaglia, MD, clinical research fellow, University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal.

    “Although reports from single-institution series show better outcomes with RARP than with an open approach, our study offers a population-based analysis of outcomes at the community level. It confirms previous investigations showing RARP is associated with substantially higher costs, but the main message is that RARP appears to have little clear benefit compared to open surgery. Nevertheless, although our study was designed to limit any effect of the steep learning curve for the robotic technique, we cannot rule out that RARP will prove to have greater benefit at a later time post-adoption.”

    The men in both study groups had a mean age of about 69 years and were predominantly Caucasian (~82%). Compared to the open surgery group, men undergoing RARP had significantly worse disease features according to analyses of clinical stage and Gleason score, but the open group had higher proportions of men with preoperative PSA >10.0 ng/mL and categorized as having high-risk disease. There were also statistically significant differences between surgical groups in pelvic lymph node dissection status and nodal stage such that patients treated with the minimally invasive approach were less likely to receive a PLND and to have nodal involvement.

    Next: No significant differences in complications

    Open vs. robot-assisted RP:Complications, readmissions

     

     

    Cheryl Guttman Krader
    Cheryl Guttman Krader is a contributor to Dermatology Times, Ophthalmology Times, and Urology Times.

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