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Objectives <p>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).</p> Materials and methods <p>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 (<i>n</i> = 10,040) from hospitals using a robot for at least 95% of their surgeries. ORP cohort included all men (<i>n</i> = 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.</p> Results <p>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, <i>p</i> &lt; 0.001] and 0.79 [0.68–0.92, <i>p</i> = 0.003], respectively). Index hospitalisation duration was shorter for RARP (6.7 ± 4.0 days vs. 9.9 ± 5.0 days, <i>p</i> &lt; 0.01). At follow-up, care for urinary incontinence and erectile dysfunction were less frequent with RARP (29.7% vs. 37.3%; <i>p</i> &lt; 0.01 and 52.1% vs. 56.3%; <i>p</i> &lt; 0.01, respectively). Results were similar with all patients after IPTW adjustment except no difference for erectile dysfunction care.</p> Conclusion <p>Compared to ORP, RARP performs better with respect to long-term survival outcomes and urinary complications.</p> Trial registration <p>ENCePP (EUPAS33290). Clinicaltrials.gov (NCT04587284).</p>

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

  • 期刊论文

  • 发表日期：

    2025年6月10日

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  • Grégoire Robert,
  • Patrick Blin,
  • Franck Bladou,
  • Jérémy Jové,
  • Eric Ouattara,
  • Magali Rouyer,
  • Cécile Droz-Perroteau,
  • Laurent Piazza,
  • Nathalie Preaubert

摘要

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).