title: Comparative effectiveness of prostate cancer surgical treatments: a population based analysis of postoperative outcomes.
abstract: OBJECTIVE
  Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic prostatectomy with or without robotic assistance vs open radical prostatectomy in terms of postoperative outcomes and subsequent cancer directed therapy.
  
  
  METHODS
  Using a population based cancer registry linked with Medicare claims we identified men 66 years old or older with localized prostate cancer who underwent radical prostatectomy from 2003 to 2005. Outcome measures were general medical/surgical complications and mortality within 90 days after surgery, genitourinary/bowel complications within 365 days, radiation therapy and/or androgen deprivation therapy within 365 days and length of hospital stay.
  
  
  RESULTS
  Of the 5,923 men 18% underwent laparoscopic radical prostatectomy. Adjusting for patient and tumor characteristics, there were no differences in the rate of general medical/surgical complications (OR 0.93 95% CI 0.77-1.14) or genitourinary/bowel complications (OR 0.96 95% CI 0.76-1.22), or in postoperative radiation and/or androgen deprivation (OR 0.80 95% CI 0.60-1.08). Laparoscopic prostatectomy was associated with a 35% shorter hospital stay (p <0.0001) and a lower bladder neck/urethral obstruction rate (OR 0.74, 95% CI 0.58-0.94). In laparoscopic cases surgeon volume was inversely associated with hospital stay and the odds of any genitourinary/bowel complication.
  
  
  CONCLUSIONS
  Laparoscopic prostatectomy and open radical prostatectomy have similar rates of postoperative morbidity and additional treatment. Men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision making and set realistic expectations.
authors.affiliation: Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, and Health Outcomes Research Group, New York, New York, USA. lowrancw@mskcc.org
authors.forename: William T
authors.initials: WT
authors.lastname: Lowrance
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Jacks
authors.forename: David S
authors.initials: DS
authors.lastname: Yee
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Jang
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Laudone
authors.forename: Bertrand D
authors.initials: BD
authors.lastname: Guillonneau
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome