title: Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival.
abstract: OBJECTIVE
  We compared biochemical recurrence-free survival of patients who underwent radical retropubic prostatectomy vs robot assisted laparoscopic prostatectomy in concurrent series at a single institution.
  
  
  METHODS
  A total of 2,132 patients were treated between June 2003 and January 2008. We excluded from study patients with prior treatment (115), missing data (83) and lymph node involvement (30). The remaining cohort (1,904) was compared based on clinical, surgical and pathological factors. Kaplan-Meier analysis was performed comparing biochemical recurrence after robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy. A Cox proportional hazards model was generated to determine whether surgical approach is an independent predictor of biochemical recurrence.
  
  
  RESULTS
  There were 491 radical retropubic prostatectomies (25.9%) and 1,413 robot assisted laparoscopic prostatectomies (74.1%) performed, and median followup was 10 months (IQR 2 to 23). On univariate analysis the robot assisted laparoscopic prostatectomy group was slightly lower risk with lower median prostate specific antigen (5.4 vs 5.8, p <0.01), a lower proportion of pathological grade 7-10 (48.5% vs 54.7%, p <0.01) and lower pathological stage (80.5% pT2 vs 69.6% pT2, p <0.01). The 3-year biochemical recurrence-free survival rate was similar between the robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy groups on the whole as well as when stratified by pathological stage, grade and margin status. On multivariate analysis extracapsular extension (p <0.01), pathological grade 7 or greater (p <0.01) and positive surgical margin (p <0.01) were independent predictors of biochemical recurrence while surgical approach was not.
  
  
  CONCLUSIONS
  The likelihood of biochemical recurrence was similar between groups when stratified by known risk factors of recurrence. Surgical approach was not a significant predictor of biochemical recurrence in the multivariate model. Our analysis is suggestive of comparable effectiveness for robot assisted laparoscopic prostatectomy, although longer term studies are needed.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37205, USA. Dan.barocas@vanderbilt.edu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Shady
authors.initials: S
authors.lastname: Salem
authors.forename: Yakup
authors.initials: Y
authors.lastname: Kordan
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
authors.forename: Roxelyn
authors.initials: R
authors.lastname: Baumgartner
authors.forename: Sharon
authors.initials: S
authors.lastname: Phillips
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors