1338 PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY VS. OPEN RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20121338 PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY VS. OPEN RADICAL PROSTATECTOMY Quoc-Dien Trinh, Maxine Sun, Jesse D. Sammon, Khurshid R. Ghani, Praful Ravi, Wooju Jeong, Shahrokh F. Shariat, Marco Bianchi, Jan Schmitges, Jay Jhaveri, Jens Hansen, Shyam Sukumar, Ali Dabaja, Fred Muhletaler, Piyush K. Agarwal, Craig G. Rogers, James O. Peabody, Mani Menon, and Pierre I. Karakiewicz Quoc-Dien TrinhQuoc-Dien Trinh Detroit, MI More articles by this author , Maxine SunMaxine Sun Montreal, Canada More articles by this author , Jesse D. SammonJesse D. Sammon Detroit, MI More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Detroit, MI More articles by this author , Praful RaviPraful Ravi Detroit, MI More articles by this author , Wooju JeongWooju Jeong Detroit, MI More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat New York, NY More articles by this author , Marco BianchiMarco Bianchi Montreal, Canada More articles by this author , Jan SchmitgesJan Schmitges Hamburg, Germany More articles by this author , Jay JhaveriJay Jhaveri Detroit, MI More articles by this author , Jens HansenJens Hansen Hamburg, Germany More articles by this author , Shyam SukumarShyam Sukumar Detroit, MI More articles by this author , Ali DabajaAli Dabaja Detroit, MI More articles by this author , Fred MuhletalerFred Muhletaler Detroit, MI More articles by this author , Piyush K. AgarwalPiyush K. Agarwal Detroit, MI More articles by this author , Craig G. RogersCraig G. Rogers Detroit, MI More articles by this author , James O. PeabodyJames O. Peabody Detroit, MI More articles by this author , Mani MenonMani Menon Detroit, MI More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1720AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior to the introduction and widespread dissemination of robot-assisted radical prostatectomy (RARP), population-based studies comparing open radical prostatectomy (ORP) and minimally invasive radical prostatectomy (MIRP), found no clinically significant difference in postoperative complication rates. With RARP supplanting laparoscopic radical prostatectomy (LRP) as the primary MIRP technique, there is cause to reexamine these findings. METHODS As of October 1, 2008, a robot-assisted modifier code was introduced to recognize robotic-assisted procedures approved by the U.S. Food and Drug Administration. Relying on the Nationwide Inpatient Sample between October 2008 and December 2009, patients with a primary diagnosis of prostate cancer treated with RP were identified (n=19462), for a weighted national estimate of 97388 cases. The robot-assisted modifier (ICD-9-CM 17.4x) code was used to identify RARP. Patients with the minimally invasive modifier code (ICD-9-CM 54.21) were classified as having undergone laparoscopic RP, and were removed from further analyses (n=184). The remainder of patients, with an absence of RARP or LRP codes, was determined as having undergone an ORP. Propensity-matched analysis was used to account for underlying differences in RARP and ORP cohorts. Subsequently, we compared the rates of blood transfusions, intraoperative and postoperative complications, prolonged length of stay (pLOS) beyond the 75th percentile of two days, as well as in-hospital mortality. RESULTS Of a weighted sample of 97388 RP, 61.1% were RARP, 38.0% were ORP and 0.9% were LRP. Following propensity-score matching, for RARP and ORP respectively, blood transfusion rates were 2.2 vs. 7.7% (p<0.001); intraoperative complications were 0.4 vs. 1.0% (p<0.001); postoperative complications were 9.1 vs. 11.1% (p<0.001); pLOS rates were 14.0 vs. 39.2% (p<0.001); and in-hospital mortality was 0.0 vs. 0.1% (p=0.037). CONCLUSIONS The current study represents the first objective assessment showing that RARP has supplanted ORP as the most common surgical approach for RP. Moreover, we demonstrate superior adjusted perioperative outcomes after RARP in virtually all of the examined outcomes relative to ORP. These results provide additional evidence to the ongoing RARP vs. ORP debate. In the absence of a randomized trial, existing population-based studies provide the highest level of clinical evidence in the comparison of RARP vs. ORP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e542-e543 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Quoc-Dien Trinh Detroit, MI More articles by this author Maxine Sun Montreal, Canada More articles by this author Jesse D. Sammon Detroit, MI More articles by this author Khurshid R. Ghani Detroit, MI More articles by this author Praful Ravi Detroit, MI More articles by this author Wooju Jeong Detroit, MI More articles by this author Shahrokh F. Shariat New York, NY More articles by this author Marco Bianchi Montreal, Canada More articles by this author Jan Schmitges Hamburg, Germany More articles by this author Jay Jhaveri Detroit, MI More articles by this author Jens Hansen Hamburg, Germany More articles by this author Shyam Sukumar Detroit, MI More articles by this author Ali Dabaja Detroit, MI More articles by this author Fred Muhletaler Detroit, MI More articles by this author Piyush K. Agarwal Detroit, MI More articles by this author Craig G. Rogers Detroit, MI More articles by this author James O. Peabody Detroit, MI More articles by this author Mani Menon Detroit, MI More articles by this author Pierre I. Karakiewicz Montreal, Canada More articles by this author Expand All Advertisement Advertisement Loading ...

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