Background

Our earlier analysis suggested that robot-assisted radical prostatectomy (RARP) achieved superiority over open radical prostatectomy (ORP) in terms of positive surgical margin (PSM) rates and functional outcomes.

Objective

With larger sample size and longer follow-up, the objective of this study update is to assess whether our previous findings are upheld and whether the improved PSM rates for RARP after an initial learning curve compared with ORP—as observed in our earlier analysis—ultimately resulted in improved biochemical control.

Design, setting, and participants

Prospective observational study comparing two surgical techniques; 2271 consecutive men underwent RARP (1520) or ORP (751) at a single centre from 2006 to 2016.

Outcome measurements and statistical analysis

Demographic and clinicopathological data were prospectively collected. The EPIC-QOL questionnaire was administered at baseline and 1.5, 3, 6, 12, and 24 mo. Multivariate linear regression modelled the difference in quality of life (QOL) domains against case number; logistic and Cox regression modelled the differences in PSM and biochemical recurrence (BCR) hazard ratios (HR), respectively.

Results and limitations

A total of 2206 men were included in BCR/PSM analysis and 1045 consented for QOL analysis. Superior pT2 surgical margins, early and late sexual outcomes, and early urinary outcomes were upheld and became more robust (narrowing of 95% confidence intervals [CIs]). The risk of BCR was initially higher for RARP, improved after 191 RARPs, and was 35% lower (hazard ratio [HR] 0.65, 95% CI 0.47–0.90) at final RARP, plateauing after 226 RARPs. Improved late (12–24 mo) urinary bother scores (adjusted mean difference [AMD] = 4.7, 95% CI 1.3–8.0) and irritative–obstructive scores (AMD = 3.8, 95% CI 0.9–5.6) at final RARP were demonstrated. Limitations include observational single surgeon data, possible residual confounding, and short follow-up.

Conclusions

The results from this updated analysis demonstrate that RARP can be beneficial for patients of high-volume surgeons, although more randomised studies and studies with survival outcomes are needed.

Patient summary

Robot-assisted radical prostatectomy was able to improve functional and oncological outcomes in this single surgeon's learning curve.

中文翻译：

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长期学习曲线后，通过机器人根治性前列腺切除术可实现卓越的生化复发和长期生活质量结果—对单例2206例连续病例的最新分析

背景

我们较早的分析表明，就积极的手术切缘（PSM）率和功能结局而言，机器人辅助根治性前列腺切除术（RARP）优于开放性根治性前列腺切除术（ORP）。

客观的

随着样本量的增加和随访时间的延长，本研究更新的目的是评估我们的先前研究结果是否成立，以及在最初的学习曲线后与ORP相比，RARP的RARP PSM率是否得到了改善（如我们先前的分析所示）改善了生化控制。

设计，设置和参与者

前瞻性观察性研究比较了两种手术技术；2006年至2016年，在同一中心连续2271名男性接受了RARP（1520）或ORP（751）治疗。

成果测量和统计分析

前瞻性地收集了人口统计学和临床​​病理学数据。EPIC-QOL问卷在基线和1.5、3、6、12和24 mo时进行管理。多元线性回归模拟生活质量（QOL）域与病例数之间的差异；Logistic和Cox回归分别模拟了PSM和生化复发（BCR）危险比（HR）的差异。

结果与局限性

总共2206名男性被纳入BCR / PSM分析，并且1045名男性同意进行QOL分析。优越的pT2手术切缘，早期和晚期的性结果以及早期的尿路结果得到了维持，并且变得更加健壮（缩小了95％的置信区间[CIs]）。RARP最初的BCR风险较高，在191次RARP之后有所改善，在最终的RARP下降低了35％（危险比[HR] 0.65，95％CI 0.47–0.90），在226次RARP之后达到稳定。最终RARP的晚期（12-24个月）尿液困扰评分（调整后的平均差异[AMD] = 4.7，95％CI 1.3-8.0）和刺激性-阻塞性评分（AMD = 3.8，95％CI 0.9-5.6）得到了改善。局限性包括观察到的单个外科医生数据，可能的残余混杂因素以及短期随访。

结论

这项更新后的分析结果表明，RARP对于大容量外科医生而言可能是有益的，尽管还需要更多的随机研究和具有生存结果的研究。

病人总结

机器人辅助的根治性前列腺切除术能够改善这名外科医生的学习曲线，并改善其功能和肿瘤学结局。