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. FUNDING: This study was funded by a grant from the French Ministry of Health as part of the 2018 Medico-Economic Research Program (PRME-18-0124). TRIAL REGISTRATION: ENCePP (EUPAS33290) Clinicaltrials.gov (NCT04587284)