Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients

Jonas Busch, Mark L Gonzalgo, Natalia Leva, Michelle Ferrari, Hannes Cash, Carsten Kempkensteffen, Stefan Hinz, Kurt Miller, Ahmed Magheli

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.

Conclusions: RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.

Methods: A total of 869 patients with body mass index ≥30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.

Results: Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS.

Original languageEnglish (US)
Pages (from-to)397-402
Number of pages6
JournalWorld Journal of Urology
Volume33
Issue number3
DOIs
StatePublished - 2015

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Prostatectomy
Survival
Neoplasm Grading
Recurrence
Propensity Score
Prostate-Specific Antigen
Biopsy
Proportional Hazards Models
Body Mass Index

Keywords

  • Laparoscopy
  • Oncologic outcome
  • Propensity score matching
  • Prostate cancer
  • Prostatectomy
  • Robotic surgery

ASJC Scopus subject areas

  • Urology

Cite this

Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients. / Busch, Jonas; Gonzalgo, Mark L; Leva, Natalia; Ferrari, Michelle; Cash, Hannes; Kempkensteffen, Carsten; Hinz, Stefan; Miller, Kurt; Magheli, Ahmed.

In: World Journal of Urology, Vol. 33, No. 3, 2015, p. 397-402.

Research output: Contribution to journalArticle

Busch, Jonas ; Gonzalgo, Mark L ; Leva, Natalia ; Ferrari, Michelle ; Cash, Hannes ; Kempkensteffen, Carsten ; Hinz, Stefan ; Miller, Kurt ; Magheli, Ahmed. / Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients. In: World Journal of Urology. 2015 ; Vol. 33, No. 3. pp. 397-402.
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abstract = "Objectives: To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.Conclusions: RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.Methods: A total of 869 patients with body mass index ≥30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.Results: Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 {\%} of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 {\%} of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 {\%}). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS.",
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T1 - Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients

AU - Busch, Jonas

AU - Gonzalgo, Mark L

AU - Leva, Natalia

AU - Ferrari, Michelle

AU - Cash, Hannes

AU - Kempkensteffen, Carsten

AU - Hinz, Stefan

AU - Miller, Kurt

AU - Magheli, Ahmed

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N2 - Objectives: To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.Conclusions: RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.Methods: A total of 869 patients with body mass index ≥30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.Results: Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS.

AB - Objectives: To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.Conclusions: RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.Methods: A total of 869 patients with body mass index ≥30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.Results: Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS.

KW - Laparoscopy

KW - Oncologic outcome

KW - Propensity score matching

KW - Prostate cancer

KW - Prostatectomy

KW - Robotic surgery

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