Comparative effectiveness of robot-assisted vs. open prostatectomy: a real-life nationwide study.

OBJECTIVES

To compare long-term progression-free survival (PFS) and overall survival (OS) between patients undergoing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP).

MATERIALS AND

METHODS

A cohort study was designed in the French nationwide claims database with a follow-up of 5 to 8 years. All men undergoing surgery for prostate cancer between 2012 and 2015 were selected. RARP cohort included all men (n = 10,040) from hospitals using a robot for at least 95% of their surgeries. ORP cohort included all men (n = 17,911) from hospitals without robot equipment. PFS and OS were compared using Cox proportional hazards model for 1:1 matched patients on high-dimensional propensity score (hdPS), and for all patients adjusted on inverse probability treatment weighting (IPTW) using the hdPS.

RESULTS

5,677 men could be matched with a median follow-up of 6.7 years. PFS and OS were longer with RARP compared to ORP (HR = 0.85 [95%CI: 0.79-0.91, p < 0.001] and 0.79 [0.68-0.92, p = 0.003], respectively). Index hospitalisation duration was shorter for RARP (6.7 ± 4.0 days vs. 9.9 ± 5.0 days, p < 0.01). At follow-up, care for urinary incontinence and erectile dysfunction were less frequent with RARP (29.7% vs. 37.3%; p < 0.01 and 52.1% vs. 56.3%; p < 0.01, respectively). Results were similar with all patients after IPTW adjustment except no difference for erectile dysfunction care.

CONCLUSION

Compared to ORP, RARP performs better with respect to long-term survival outcomes and urinary complications.

TRIAL REGISTRATION: ENCePP (EUPAS33290).

CLINICALTRIALS: gov (NCT04587284).