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Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England.
Br J Cancer. 2018 02 20; 118(4):489-494.BJ

Abstract

BACKGROUND

Robot-assisted radical prostatectomy (RARP) has been rapidly adopted without robust evidence comparing its functional outcomes against laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (ORP) approaches. This study compared patient-reported functional outcomes following RARP, LRP or ORP.

METHODS

All men diagnosed with prostate cancer in England during April - October 2014 who underwent radical prostatectomy were identified from the National Prostate Cancer Audit and mailed a questionnaire 18 months after diagnosis. Group differences in patient-reported sexual, urinary, bowel and hormonal function (EPIC-26 domain scores) and generic health-related quality of life (HRQoL; EQ-5D-5L scores), with adjustment for patient and tumour characteristics, were estimated using linear regression.

RESULTS

In all, 2219 men (77.0%) responded; 1310 (59.0%) had RARP, 487 (21.9%) LRP and 422 (19.0%) ORP. RARP was associated with slightly higher adjusted mean EPIC-26 sexual function scores compared with LRP (3·5 point difference; 95% CI: 1.1-5.9, P=0.004) or ORP (4.0 point difference; 95% CI: 1.5-6.5, P=0.002), which did not meet the threshold for a minimal clinically important difference (10-12 points). There were no significant differences in other EPIC-26 domain scores or HRQoL.

CONCLUSIONS

It is unlikely that the rapid adoption of RARP in the English NHS has produced substantial improvements in functional outcomes for patients.

Authors+Show Affiliations

Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK.Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK.Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK.Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK.Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK.Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK.Department of Urology, The Christie, Manchester M20 4BX, UK. Department of Urology, Salford Royal NHS Foundation Trusts, Manchester M6 8HD, UK.Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29348490

Citation

Nossiter, Julie, et al. "Robot-assisted Radical Prostatectomy Vs Laparoscopic and Open Retropubic Radical Prostatectomy: Functional Outcomes 18 Months After Diagnosis From a National Cohort Study in England." British Journal of Cancer, vol. 118, no. 4, 2018, pp. 489-494.
Nossiter J, Sujenthiran A, Charman SC, et al. Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. Br J Cancer. 2018;118(4):489-494.
Nossiter, J., Sujenthiran, A., Charman, S. C., Cathcart, P. J., Aggarwal, A., Payne, H., Clarke, N. W., & van der Meulen, J. (2018). Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. British Journal of Cancer, 118(4), 489-494. https://doi.org/10.1038/bjc.2017.454
Nossiter J, et al. Robot-assisted Radical Prostatectomy Vs Laparoscopic and Open Retropubic Radical Prostatectomy: Functional Outcomes 18 Months After Diagnosis From a National Cohort Study in England. Br J Cancer. 2018 02 20;118(4):489-494. PubMed PMID: 29348490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. AU - Nossiter,Julie, AU - Sujenthiran,Arunan, AU - Charman,Susan C, AU - Cathcart,Paul J, AU - Aggarwal,Ajay, AU - Payne,Heather, AU - Clarke,Noel W, AU - van der Meulen,Jan, Y1 - 2018/01/18/ PY - 2017/07/24/received PY - 2017/11/16/revised PY - 2017/11/21/accepted PY - 2018/1/20/pubmed PY - 2019/1/27/medline PY - 2018/1/20/entrez SP - 489 EP - 494 JF - British journal of cancer JO - Br. J. Cancer VL - 118 IS - 4 N2 - BACKGROUND: Robot-assisted radical prostatectomy (RARP) has been rapidly adopted without robust evidence comparing its functional outcomes against laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (ORP) approaches. This study compared patient-reported functional outcomes following RARP, LRP or ORP. METHODS: All men diagnosed with prostate cancer in England during April - October 2014 who underwent radical prostatectomy were identified from the National Prostate Cancer Audit and mailed a questionnaire 18 months after diagnosis. Group differences in patient-reported sexual, urinary, bowel and hormonal function (EPIC-26 domain scores) and generic health-related quality of life (HRQoL; EQ-5D-5L scores), with adjustment for patient and tumour characteristics, were estimated using linear regression. RESULTS: In all, 2219 men (77.0%) responded; 1310 (59.0%) had RARP, 487 (21.9%) LRP and 422 (19.0%) ORP. RARP was associated with slightly higher adjusted mean EPIC-26 sexual function scores compared with LRP (3·5 point difference; 95% CI: 1.1-5.9, P=0.004) or ORP (4.0 point difference; 95% CI: 1.5-6.5, P=0.002), which did not meet the threshold for a minimal clinically important difference (10-12 points). There were no significant differences in other EPIC-26 domain scores or HRQoL. CONCLUSIONS: It is unlikely that the rapid adoption of RARP in the English NHS has produced substantial improvements in functional outcomes for patients. SN - 1532-1827 UR - https://www.unboundmedicine.com/medline/citation/29348490/Robot_assisted_radical_prostatectomy_vs_laparoscopic_and_open_retropubic_radical_prostatectomy:_functional_outcomes_18_months_after_diagnosis_from_a_national_cohort_study_in_England_ L2 - http://dx.doi.org/10.1038/bjc.2017.454 DB - PRIME DP - Unbound Medicine ER -