Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 Consortium

• Published in: The Journal of urology Vol. 207; no. 1; pp. 127 - 136
• Main Authors: Chang, Peter, Wagner, Andrew A., Regan, Meredith M., Smith, Joseph A., Saigal, Christopher S., Litwin, Mark S., Hu, Jim C., Cooperberg, Matthew R., Carroll, Peter R., Klein, Eric A., Kibel, Adam S., Andriole, Gerald L., Han, Misop, Partin, Alan W., Wood, David P., Crociani, Catrina M., Greenfield, Thomas K., Patil, Dattatraya, Hembroff, Larry A., Davis, Kyle, Stork, Linda, Spratt, Daniel E., Wei, John T., Sanda, Martin G.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Wolters Kluwer 01.01.2022
• Subjects: Aged; Humans; Laparoscopy; Male; Middle Aged; Prospective Studies; Prostatectomy - methods; Prostatic Neoplasms - surgery; Quality of Life; Robotic Surgical Procedures; Treatment Outcome; robotic surgical procedures; quality of life; prostatectomy
• ISSN: 0022-5347; 1527-3792; 1527-3792
• DOI: 10.1097/JU.0000000000002176

Purpose:Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study.Materials and Methods:We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications.Results:Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain.Conclusions:In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.