Abstract
Simple SummaryFew studies have evaluated oncologic outcomes in patients with prostate cancer (PC) receiving open, laparoscopic, or robotic radical prostatectomy (RP). To the best of our knowledge, this is the first and largest study to examine PSM and BFS rates in patients with PC undergoing open, laparoscopic, or robotic RP. After adjustment for confounders, no significant differences in PSM or BFS were noted among the patient groups.Purpose: To estimate the rates of positive surgical margin (PSM) and biochemical failure–free survival (BFS) among patients with prostate cancer (PC) receiving open, laparoscopic, or robotic radical prostatectomy (RP). Patients and Methods: The patients were men enrolled in the Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP. After adjustment for confounders, logistic regression was used to model the risk of PSM following RP. After adjustment for confounders, Cox proportional regression was used to model the time from the index (i.e., surgical) date to biochemical recurrence. Results: The adjusted odds ratios (95% CIs) of PSM risk after propensity score adjustment for laparoscopic versus open, robotic versus open, and robotic versus laparoscopic RP 95% CIs were 1.25 (0.88 to 1.77; p = 0.2064), 1.16 (0.88 to 1.53; p = 0.2847), and 0.93 (0.70 to 1.24; p = 0.6185), respectively. The corresponding adjusted hazard ratios (95% CIs) of risk of biochemical failure after propensity score adjustment were 1.16 (0.93 to 1.47; p = 0.1940), 1.10 (0.83 to 1.47; p = 0.5085), and 0.95 (0.74 to 1.21; p = 0.6582). Conclusions: No significant differences in PSM or BFS were observed among patients receiving open, laparoscopic, or robotic RP.
Highlights
With an estimated 1,100,000 new cases and 307,000 deaths in 2012, prostate cancer (PC)is the second most common cancer affecting men worldwide [1]
Analyses of large databases indicate that robotic radical prostatectomy (RP) has increased rapidly in popularity, constituting the modality used in the majority of cases [4,5]
The type of RP we examined was surgery to remove the entire prostate gland and the surrounding lymph nodes as treatment for men with localized PC [21]
Summary
Is the second most common cancer affecting men worldwide [1]. In Taiwan, PC is the fifth most common cancer in men. Treatment for PC, which depends on age, expected lifespan, and clinical staging, includes surgery, radiotherapy, hormone therapy, chemotherapy, active surveillance, or a combination of these [2]. Cancer Network [3], for men with newly diagnosed PC, the most important factors in initial treatment selection include the anatomic extent of disease (tumor [T] stage), histologic grade (Gleason score or grade group), serum prostate-specific antigen (PSA) concentration, and age, as well as risk stratification schema for localized PC. Irradiation; the choice is largely a matter of patient preference [3], with most patients who choose surgery undergoing retropubic RP as the standard approach. Analyses of large databases indicate that robotic RP has increased rapidly in popularity, constituting the modality used in the majority of cases [4,5]
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