The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples.
OBJECTIVE
Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy.


METHODS
Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS.


RESULTS
The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09-6.44) but not at 12 months (1.19, -1.32-3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02-10.56) and at 12 months (7.64, 5.25-10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results.


CONCLUSIONS
This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience less decline in early urinary continence and sexual function than those undergoing open radical prostatectomy. The clinical meaning of these differences is uncertain and longer followup will be required to establish whether these benefits are durable.
Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee. Electronic address: brock.oneil@vanderbilt.edu.
Brock
B
O'Neil
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
Tatsuki
T
Koyama
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
JoAnn
J
Alvarez
CEASAR Patient Advocacy Network.
Ralph M
RM
Conwill
Division of Urology, University of Connecticut Health Center, Farmington, Connecticut.
Peter C
PC
Albertsen
Department of Urology, University of California San Francisco, San Francisco.
Matthew R
MR
Cooperberg
Department of Epidemiology, Emory University, Atlanta, Georgia.
Michael
M
Goodman
Department of Medicine, University of California, Irvine, Irvine.
Sheldon
S
Greenfield
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Ann S
AS
Hamilton
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Karen E
KE
Hoffman
Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Richard M
RM
Hoffman
Department of Medicine, University of California, Irvine, Irvine.
Sherrie H
SH
Kaplan
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Janet L
JL
Stanford
New Jersey State Cancer Registry, Trenton, New Jersey.
Antoinette M
AM
Stroup
New Jersey State Cancer Registry, Trenton, New Jersey.
Lisa E
LE
Paddock
Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Xiao-Cheng
XC
Wu
Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Robert A
RA
Stephenson
Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee.
Matthew J
MJ
Resnick
Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee.
Daniel A
DA
Barocas
Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee.
David F
DF
Penson
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
patient outcome assessment; prostatectomy; robotics