Anastomotic strictures after robot-assisted and open radical prostatectomy

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

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Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health Service

European Urology ◽

10.1016/j.eururo.2013.02.040 ◽

2013 ◽

Vol 64 (3) ◽

pp. 361-369 ◽

Cited By ~ 55

Author(s):

Andrew Close ◽

Clare Robertson ◽

Stephen Rushton ◽

Mark Shirley ◽

Luke Vale ◽

...

Keyword(s):

Prostate Cancer ◽

Cost Effectiveness ◽

National Health Service ◽

Radical Prostatectomy ◽

Health Technology ◽

Robot Assisted ◽

Comparative Cost ◽

Open Radical Prostatectomy ◽

Uk National Health Service ◽

The Uk

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Complications following robot-assisted radical prostatectomy in a prospective Canadian cohort of 305 consecutive cases

Canadian Urological Association Journal ◽

10.5489/cuaj.818 ◽

2013 ◽

Vol 7 (3-4) ◽

pp. 116-21 ◽

Cited By ~ 2

Author(s):

Andrew Fuller ◽

Stephen E. Pautler

Keyword(s):

Radical Prostatectomy ◽

Major Complication ◽

Robot Assisted ◽

Pharmacological Management ◽

Surgical Technology ◽

Related Information ◽

Open Radical Prostatectomy ◽

Institutional Ethics ◽

Patient Consent

Background: Robot-assisted radical prostatectomy (RARP) has emerged in the last decade as an alternative to open radical prostatectomy for men with localized prostate cancer. The increased cost of this technique has been justified by its ability to reduce blood loss, and to provide improved vision, less postoperative pain and more rapid recovery from surgery, while maintaining satisfactory oncological and functional outcomes. Given the increasing diffusion of robotic surgical technology within Canada and its associated high capital and operating costs, we review the clinical outcomes and complications from 305 consecutive cases performed at our Canadian institution.Methods: A consecutive cohort of 305 patients with a mean follow up of 30 months was analyzed with institutional ethics approval. All patients were treated and reviewed postoperatively by a single surgeon (SP). The primary aim of the study was to assess the incidence and type of complications associated with RARP in a Canadian setting. Our prospective database captured preoperative, intra-operative and postoperative data and was maintained by an individual independent of the robotic program. We report complications categorized according to the Clavien system. Multiple complications seen in an individual were recorded separately for the purposes of our analysis.Results: Between April 2005 and October 2010, 305 patients underwent RARP at our institution. A total of 70 complications were identified, with 47 (67.1%) requiring only conservative or pharmacological management (Clavien I-II). Twenty-three patients were found to have a major complication (Clavien III-V). Of the 16 who required intervention under general anesthesia, 3 required emergency treatment and the remaining patients underwent elective surgery.Conclusions: RARP has been incorporated at our institution with an acceptably low rate of intra-operative and postoperative complications. We have found that the database was effective in providing patients with outcome-related information, which in turn helped us gain patient consent with regard to the institution-specific risks of RARP.

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A comparative study of robot-assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

BJU International ◽

10.1111/bju.14760 ◽

2019 ◽

Vol 123 (6) ◽

pp. 1031-1040 ◽

Cited By ~ 21

Author(s):

Alexander Haese ◽

Sophie Knipper ◽

Hendrik Isbarn ◽

Hans Heinzer ◽

Derya Tilki ◽

...

Keyword(s):

Radical Prostatectomy ◽

Comparative Study ◽

Robot Assisted ◽

Open Radical Prostatectomy

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Robot-Assisted Versus Open Radical Prostatectomy: The Differential Effect of Regionalization, Procedure Volume and Operative Approach

The Journal of Urology ◽

10.1016/j.juro.2012.10.028 ◽

2013 ◽

Vol 189 (4) ◽

pp. 1289-1294 ◽

Cited By ~ 50

Author(s):

Jesse D. Sammon ◽

Pierre I. Karakiewicz ◽

Maxine Sun ◽

Shyam Sukumar ◽

Praful Ravi ◽

...

Keyword(s):

Radical Prostatectomy ◽

Differential Effect ◽

Operative Approach ◽

Robot Assisted ◽

Open Radical Prostatectomy ◽

Procedure Volume

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Detrusorrhaphy during Robot-Assisted Radical Prostatectomy: Early Recovery of Urinary Continence and Surgical Technique

BioMed Research International ◽

10.1155/2019/1528142 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Tae Young Shin ◽

Yong Seong Lee

Keyword(s):

Urinary Incontinence ◽

Radical Prostatectomy ◽

Intraoperative Complications ◽

Risk Groups ◽

Catheter Removal ◽

Urinary Continence ◽

Nerve Sparing ◽

Robot Assisted ◽

Early Recovery ◽

Open Radical Prostatectomy

Robot-assisted radical prostatectomy (RARP) has largely replaced open radical prostatectomy as the standard surgical treatment for prostate cancer. However, postoperative urinary incontinence still persists and has a significant impact on quality of life. We report the superior results of the detrusorrhaphy technique during RARP that helps achieve early continence. Our prospective study involved 95 consecutive patients who underwent RARP between March 2015 and May 2017; fifty patients underwent RARP using the new detrusorrhaphy technique (group 1) and 45 underwent standard RARP (group 2). The postoperative oncological and functional outcomes were compared between the two groups. The postoperative continence was assessed at 0 day, 1 week, 4 weeks, 8–12 weeks, and 6 months after catheter removal. Continence was defined as the use of no pad over a 24 h period. Mean operative time in groups 1 and 2 were 250 and 220 min, respectively. Intraoperative complications were not encountered in any patient. The continence rates after catheter removal in groups 1 and 2 were 68% and 0% at 0 day, 78% and 17.8% at 1 week, 86% and 64.4% at 4 weeks, 92% and 73.3% at 8–12 weeks, and 100% and 91.1% at 6 months, respectively. In the multivariate analysis, the nerve sparing technique, D’Amico risk groups, and prostate volume were involved in the early recovery of urinary continence. The detrusorrhaphy technique is simple, safe, and feasible, which helped achieve earlier continence. It showed significantly better outcomes than those achieved with the standard RARP technique in terms of urinary incontinence. Nevertheless, our findings need to be validated in further studies.

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