title: Robot-assisted radical prostatectomy in the Korean population: a 5-year propensity-score matched comparative analysis versus open radical prostatectomy.
abstract: OBJECTIVE
  To compare the oncological outcomes of robot-assisted laparoscopic radical prostatectomy with those of open radical prostatectomy in contemporary Korean prostate cancer patients.
  
  
  METHODS
  From a group of 1172 patients consisting of 592 (50.5%) robot-assisted laparoscopic radical prostatectomy and 580 (49.5%) open radical prostatectomy cases carried out between 1992 and 2008, 175 robot-assisted laparoscopic radical prostatectomy cases were matched with an equal number of open radical prostatectomy cases by propensity scoring based on patient age, preoperative prostate-specific antigen, biopsy Gleason score and clinical tumor stage. Competing-risks survival analyses were used to evaluate oncological outcomes, including rates of positive surgical margin, biochemical-recurrence, adjuvant therapy, cancer-specific survival, overall survival and metastasis-free survival during the mean follow up of 58.4 months.
  
  
  RESULTS
  Positive surgical margin rates were comparable between robot-assisted laparoscopic radical prostatectomy and open radical prostatectomy cohorts (19.4% vs 21.8%), with comparable rates for all pathological stages and risk subgroups. Positive surgical margin rates according to location were comparable, with the apical margin being the most common location. Robot-assisted laparoscopic radical prostatectomy recovered higher lymph node yields compared with open radical prostatectomy (12.5 vs 3.8; P < 0.001). The robot-assisted laparoscopic radical prostatectomy and the open radical prostatectomy groups showed equal oncological outcomes regarding 5-year biochemical recurrence-free survival (log-rank P = 0.651), metastasis-free survival (log-rank P = 0.876), cancer-specific survival (log-rank P = 0.076) and overall survival (log-rank P = 0.648), respectively. Between groups, there was no difference in the rate of adjuvant therapy, time to first adjuvant therapy failure or in the rate of subsequent secondary treatment.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic radical prostatectomy represents an effective surgical approach for the treatment of prostate cancer in the Korean population, as it provides equivalent oncological outcomes to open radical prostatectomy.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyo Chul
authors.initials: KC
authors.lastname: Koo
authors.forename: Patrick
authors.initials: P
authors.lastname: Tuliao
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Yoon
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Seung Choul
authors.initials: SC
authors.lastname: Yang
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D056910:Republic of Korea; D012371:Robotics; D016896:Treatment Outcome
keywords: prostate cancer; prostatectomy; robotics; treatment outcome