Long-term functional outcomes after robot-assisted prostatectomy compared to laparoscopic prostatectomy: Results from a national retrospective cluster study

• Published in: European journal of surgical oncology Vol. 47; no. 10; pp. 2658 - 2666
• Main Authors: Lindenberg, Melanie (M.A.), Retèl, Valesca (V.P.), Kieffer, Jacobien (J.M.), Wijburg, Carl (C.), Fossion, Laurent (L.M.C.L), van der Poel, Henk (H.G.), van Harten, Wim (W.H.)
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2021
• Subjects: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Vessels; Erectile Dysfunction - etiology; Follow-Up Studies; Hormones - therapeutic use; Humans; Laparoscopic prostatectomy; Laparoscopy - adverse effects; Male; Middle Aged; Netherlands; Operative Time; Organ Sparing Treatments; Patient-reported outcomes; Peripheral Nerves; Postoperative Complications - etiology; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - surgery; Quality of Life; Retrospective Studies; Robot-assisted prostatectomy; Robotic Surgical Procedures - adverse effects; Sexual functioning; Surveys and Questionnaires; Time Factors; Urinary functioning; Urinary Incontinence - etiology; Netherlands; Patient-reported outcomes; Sexual functioning; Urinary functioning; Robot-assisted prostatectomy; Laparoscopic prostatectomy
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2021.06.006

Despite multiple studies evaluating the effectiveness of Robot-Assisted Radical Prostatectomy (RARP), there is no definitive conclusion about the added value of RARP. A retrospective cluster study was conducted to evaluate long-term sexual and urinary functioning after RARP and Laparoscopic Radical Prostatectomy (LRP) based on real-world data from 12 Dutch hospitals. Data was collected from patients who underwent surgery between 2010 and 2012. A mixed effect model was used to evaluate differences between groups on urinary and sexual functioning (EPIC-26). Additionally, a regression analysis was conducted to evaluate the relationship between these functional outcomes and, among others, hospital volume. 1370 (65.1%) patients participated, 907 underwent RARP and 463 LRP, with a median follow-up time of 7.08 years (SD = 0.98). The RARP group showed a statistically and clinically significant better urinary functioning compared to the LRP group (p = 0.002). RARP showed also a shorter procedure time (p=<0.001), reduced blood loss (p=<0.001), and a higher chance of neurovascular bundle preservation (39.8% vs 29.1%; p=<0.01). RARP resulted in better long-term urinary function compared to LRP. Based on the results from this study, guidelines concerning the preferred surgery type and the position on reimbursement may change, especially when RARP proves to be cost-effective.