title: Benchmarks for operative outcomes of robotic and open radical prostatectomy: results from the Health Professionals Follow-up Study.
abstract: BACKGROUND
  Robot-assisted laparoscopic radical prostatectomy (RALP) has become increasingly common; however, there have been no nationwide, population-based, non-claims-based studies to evaluate differences in outcomes between RALP and open radical retropubic prostatectomy (RRP).
  
  
  OBJECTIVE
  To determine surgical, oncologic, and health-related quality of life (HRQOL) outcomes following RALP and RRP in a nationwide cohort.
  
  
  METHODS
  We identified 903 men in the Health Professionals Follow-up Study diagnosed with prostate cancer between 2000 and 2010 who underwent radical prostatectomy using RALP (n=282) or RRP (n=621) as primary treatment.
  
  
  METHODS
  Radical prostatectomy.
  
  
  METHODS
  We compared patients undergoing RALP or RRP across a range of perioperative, oncologic, and HRQOL outcomes.
  
  
  CONCLUSIONS
  Use of RALP increased during the study period, constituting 85.2% of study subjects in 2009, up from 4.5% in 2003. Patients undergoing RALP compared to RRP were less likely to have a lymph node dissection (51.5% vs 85.4%; p<0.0001), had less blood loss (207.4 ml vs 852.3 ml; p<0.0001), were less likely to receive blood transfusions (4.3% vs 30.3%; p<0.0001), and had shorter hospital stays (1.8 d vs 2.9 d; p<0.0001). Surgical, oncologic, and HRQOL outcomes did not differ significantly among the groups. In multivariate logistic regression models, there were no significant differences in 3- or 5-yr recurrence-free survival comparing RALP versus RRP (hazard ratios: 0.98 [95% confidence interval (CI), 0.46-2.08] and 0.75 [95% CI, 0.18-3.11], respectively).
  
  
  CONCLUSIONS
  In a nationwide cohort of patients undergoing surgical treatment for prostate cancer, RALP was associated with shorter hospital stay, and lower blood loss and transfusion rates than RRP. Surgical oncologic and HRQOL outcomes were similar between groups.
  
  
  RESULTS
  We studied men throughout the United States with prostate cancer who underwent surgical removal of the prostate. We found that robot-assisted laparoscopic radical prostatectomy resulted in shorter hospital stay, less blood loss, and fewer blood transfusions than radical retropubic prostatectomy. There were no differences in cancer control or health-related quality of life.
authors.affiliation: USC Institute of Urology, Keck Medical Center at USC, Los Angeles, CA, USA. Electronic address: malemozaffar@gmail.com.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Alemozaffar
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Sanda
authors.affiliation: Boston University School of Medicine, Boston, MA, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Yecies
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Lorelei A
authors.initials: LA
authors.lastname: Mucci
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Meir J
authors.initials: MJ
authors.lastname: Stampfer
authors.affiliation: Department of Urology, University of California, San Francisco, CA, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Kenfield
mesh_terms: D000368:Aged; D019985:Benchmarking / Q000592:standards*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008197:Lymph Node Excision / Q000592:standards; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D017064:Process Assessment, Health Care / Q000592:standards*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019984:Quality Indicators, Health Care / Q000592:standards*; D011788:Quality of Life; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Health-related quality of life; Open; Outcomes; Prostatectomy; Robotic