Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy

An analysis using propensity score matching

Ahmed Magheli, Mark L. Gonzalgo, Li Ming Su, Thomas J. Guzzo, George Netto, Elizabeth B. Humphreys, Misop Han, Alan Wayne Partin, Christian Pavlovich

Research output: Contribution to journalArticle

Abstract

OBJECTIVE To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. PATIENTS AND METHODS A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. Pathological and biochemical outcomes of the three cohorts were examined. RESULTS Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P <0.001) and preoperative PSA (P <0.001) were predictors of positive surgical margins. Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.

Original languageEnglish (US)
Pages (from-to)1956-1962
Number of pages7
JournalBJU International
Volume107
Issue number12
DOIs
StatePublished - Jun 2011

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Propensity Score
Robotics
Prostatectomy
Neoplasm Grading
Prostate-Specific Antigen
Biopsy
Recurrence
Kaplan-Meier Estimate

Keywords

  • biochemical recurrence
  • laparoscopic prostatectomy
  • prostate cancer
  • radical prostatectomy
  • robotic prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy : An analysis using propensity score matching. / Magheli, Ahmed; Gonzalgo, Mark L.; Su, Li Ming; Guzzo, Thomas J.; Netto, George; Humphreys, Elizabeth B.; Han, Misop; Partin, Alan Wayne; Pavlovich, Christian.

In: BJU International, Vol. 107, No. 12, 06.2011, p. 1956-1962.

Research output: Contribution to journalArticle

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title = "Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: An analysis using propensity score matching",
abstract = "OBJECTIVE To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. PATIENTS AND METHODS A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. Pathological and biochemical outcomes of the three cohorts were examined. RESULTS Overall positive surgical margin rates were lower among patients who underwent RRP (14.4{\%}) and LRP (13.0{\%}) compared to patients who underwent RARP (19.5{\%}) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P <0.001) and preoperative PSA (P <0.001) were predictors of positive surgical margins. Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.",
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T1 - Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy

T2 - An analysis using propensity score matching

AU - Magheli, Ahmed

AU - Gonzalgo, Mark L.

AU - Su, Li Ming

AU - Guzzo, Thomas J.

AU - Netto, George

AU - Humphreys, Elizabeth B.

AU - Han, Misop

AU - Partin, Alan Wayne

AU - Pavlovich, Christian

PY - 2011/6

Y1 - 2011/6

N2 - OBJECTIVE To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. PATIENTS AND METHODS A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. Pathological and biochemical outcomes of the three cohorts were examined. RESULTS Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P <0.001) and preoperative PSA (P <0.001) were predictors of positive surgical margins. Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.

AB - OBJECTIVE To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. PATIENTS AND METHODS A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. Pathological and biochemical outcomes of the three cohorts were examined. RESULTS Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P <0.001) and preoperative PSA (P <0.001) were predictors of positive surgical margins. Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.

KW - biochemical recurrence

KW - laparoscopic prostatectomy

KW - prostate cancer

KW - radical prostatectomy

KW - robotic prostatectomy

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