Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination Era

2014 ◽  
Vol 32 (14) ◽  
pp. 1419-1426 ◽  
Author(s):  
Giorgio Gandaglia ◽  
Jesse D. Sammon ◽  
Steven L. Chang ◽  
Toni K. Choueiri ◽  
Jim C. Hu ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Length Of Stay ◽  
Lower Risk ◽  
Surgical Approaches ◽  
First Year ◽  
Blood Transfusions ◽  
Cancer Therapies ◽  
Robot Assisted ◽  
Prolonged Length ◽  
Open Radical Prostatectomy

Purpose Given the lack of randomized trials comparing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we sought to re-examine the outcomes of these techniques using a cohort of patients treated in the postdissemination era. Patients and Methods Overall, data from 5,915 patients with prostate cancer treated with RARP or ORP within the SEER-Medicare linked database diagnosed between October 2008 and December 2009 were abstracted. Postoperative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies, and costs of care within the first year after surgery were compared between the two surgical approaches. To decrease the effect of unmeasured confounders, instrumental variable analysis was performed. Multivariable logistic regression analyses were then performed. Results Overall, 2,439 patients (41.2%) and 3,476 patients (58.8%) underwent ORP and RARP, respectively. In multivariable analyses, patients undergoing RARP had similar odds of overall complications, readmission, and additional cancer therapies compared with patients undergoing ORP. However, RARP was associated with a higher probability of experiencing 30- and 90-day genitourinary and miscellaneous medical complications (all P ≤ .02). Additionally, RARP led to a lower risk of experiencing blood transfusion and of having a pLOS (all P < .001). Finally, first-year reimbursements were greater for patients undergoing RARP compared with ORP (P < .001). Conclusion RARP and ORP have comparable rates of complications and additional cancer therapies, even in the postdissemination era. Although RARP was associated with lower risk of blood transfusions and a slightly shorter length of stay, these benefits do not translate to a decrease in expenditures.

scholarly journals Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

2020 ◽  
Vol 14 (8) ◽  
Author(s):  
Anna Parackal ◽  
Jean-Eric Tarride ◽  
Feng Xie ◽  
Gord Blackhouse ◽  
Jennifer Hoogenes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Base Case ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Life Years

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.

Utilization and Timing of Blood Transfusions Following Open and Robot-Assisted Radical Prostatectomy

2014 ◽  
Vol 28 (12) ◽  
pp. 1418-1423 ◽  
Author(s):  
Ruslan Korets ◽  
Aaron C. Weinberg ◽  
Blake D. Alberts ◽  
Solomon L. Woldu ◽  
Mark J. Mann ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusions ◽  
Robot Assisted

Advantages and disadvantages of main surgical approaches for robot-assisted radical prostatectomy

2020 ◽  
Vol 10 (4) ◽  
pp. 347-354
Author(s):  
Dmitriy M. Il’in ◽  
Vladimir A. Makeev
Keyword(s):  
Radical Prostatectomy ◽  
Abdominal Cavity ◽  
Prostate Gland ◽  
Clinical Situation ◽  
Surgical Approaches ◽  
Robot Assisted ◽  
Scientific Databases ◽  
Advantages And Disadvantages ◽  
Robotic Assisted Surgery ◽  
History Of

The introduction of robotic-assisted surgery into clinical practice has opened up new possibilities for the surgical treatment of urological patients. Robot-assisted radical prostatectomy (RARP) is one of the most commonly performed robot-assisted surgery. The review is devoted to the main surgical approaches for RARP. An analysis of publications on this topic was carried out using the search engines of the scientific databases PubMed, Medscape, Google Scholar, eLibrary when writing the article The article presents an overview of the advantages and disadvantages of the existing four access options for RARP: anterior, perineal, lateral and posterior, as well as oncological and functional outcomes of operations. It has been shown that a surgeon with different approaches can choose the most suitable one for a given clinical situation, focusing on the stage of the disease, the patients age, anatomical features of the prostate gland, the state of the patients erectile function, and the history of operations on the abdominal cavity and pelvic organs.

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

2013 ◽  
Vol 7 (3-4) ◽  
pp. 116-21 ◽  
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.

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

2019 ◽  
Vol 123 (6) ◽  
pp. 1031-1040 ◽  
Author(s):  
Alexander Haese ◽  
Sophie Knipper ◽  
Hendrik Isbarn ◽  
Hans Heinzer ◽  
Derya Tilki ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Comparative Study ◽  
Robot Assisted ◽  
Open Radical Prostatectomy

scholarly journals Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

2014 ◽  
Vol 8 (9-10) ◽  
pp. 695 ◽  
Author(s):  
Vincent Trudeau ◽  
Giorgio Gandaglia ◽  
Jonas Shiffmann ◽  
Ioana Popa ◽  
Shahrokh F Shariat ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Perioperative Complications ◽  
Large Population ◽  
Laparoscopic Approach ◽  
Population Based ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Lower Probability ◽  
Weighted Estimate ◽  
Prolonged Length

Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large population-based cohort of patients with upper-tract urothelial carcinoma (UTUC).Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures.Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade.Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU.

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

2013 ◽  
Vol 189 (4) ◽  
pp. 1289-1294 ◽  
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

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

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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