1781 BENCHMARKS FOR OPERATIVE OUTCOMES OF ROBOTIC LAPAROSCOPIC AND OPEN RADICAL PROSTATECTOMY BASED ON RESULTS FROM A NATIONWIDE AMERICAN COHORT: THE HEALTH PROFESSIONALS FOLLOW-UP STUDY

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You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111781 BENCHMARKS FOR OPERATIVE OUTCOMES OF ROBOTIC LAPAROSCOPIC AND OPEN RADICAL PROSTATECTOMY BASED ON RESULTS FROM A NATIONWIDE AMERICAN COHORT: THE HEALTH PROFESSIONALS FOLLOW-UP STUDY Mehrdad Alemozaffar, Martin Sanda, Derek Yecies, Meir Stampfer, and Stacey Kenfield Mehrdad AlemozaffarMehrdad Alemozaffar Boston, MA More articles by this author , Martin SandaMartin Sanda Boston, MA More articles by this author , Derek YeciesDerek Yecies Boston, MA More articles by this author , Meir StampferMeir Stampfer Boston, MA More articles by this author , and Stacey KenfieldStacey Kenfield Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multi-center evaluations of robot-assisted laparosopic prostatectomy (RALP) and radical retropubic prostatectomy (RRP) operative outcomes have previously been limited to tertiary academic centers whose generalizability to community practice is uncertain, or to claims-based analyses of Medicare cohorts lacking consistent medical record confirmation. We sought to evaluate outcomes of RALP and RRP in a nationwide, community-based cohort to establish generalizable benchmarks for expected outcomes. METHODS The Health Professionals Follow-up Study (HPFS) cohort of 51,529 men residing in all 50 US states was interrogated to evaluate outcomes of all men who underwent prostatectomy for prostate cancer from 2000 to 2008. Peri-operative, post-operative and pathology data were collected from medical records. Analyses were performed using SAS. RESULTS Among all 2899 men diagnosed with prostate cancer from 2000 to 2008, 843 men underwent prostatectomy: 64% RRP, 19% RALP, 3% laparoscopic prostatectomy, and 3% perineal prostatectomy. RALP use increased during the study, representing 1% of prostatectomies in 2002, and 62% by 2007. Tumor severity was greater among RRP than RALP patients (T2 stage in 34.6% vs. 22.7%, p=0.007; higher PSA among RRP than RALP, p<0.003; D'Amico high risk cancer in 12.1% RRP vs. 6.0% RALP, p=0.04). Peri-operative outcome comparison between RRP and RALP groups demonstrated no difference in rates of nerve-sparing (p=0.93), but RRP patients were more likely to undergo lymphadenectomy (85.4% vs. 46.5%, respectively, p<0.0001). RRP patients experienced greater mean estimated blood loss (824.2 ml vs. 186.0 ml, p<0.001), were more likely to receive blood transfusion (30.5% vs. 4.9%, p<0.001), and had longer mean hospital stay (2.9 days vs. 1.9 days, p<0.003) than did patients who had RALP. Oncologic outcomes between RRP and RALP revealed no difference in prostatectomy pathologic stage, gleason score, or rates of positive surgical margins (22.5% vs. 25.0%, respectively; p=0.52). CONCLUSIONS In this nationwide, community-based cohort that provides broadly generalizable benchmarks of prostatectomy outcomes, RALP was associated with shorter hospital stay and less blood loss (requiring fewer transfusions) than RRP, while yielding similar oncologic outcomes (as measured by positive surgical margin rates). However, cancer severity was lower in patients undergoing RALP, suggesting a need for risk-based recurrence assessment during ongoing follow-up. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185 Issue 4S April 2011 Page: e715 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Mehrdad Alemozaffar Boston, MA More articles by this author Martin Sanda Boston, MA More articles by this author Derek Yecies Boston, MA More articles by this author Meir Stampfer Boston, MA More articles by this author Stacey Kenfield Boston, MA More articles by this author Expand All Advertisement Advertisement PDF