Objective: To examine the characteristics of robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) patients at a high-volume center. Patients and Methods: We relied on the Martini-Clinic database and focused on prostate cancer patients treated in 2013. Characteristics in ORP and RARP patients were assessed. In multivariable logistic regression analyses (MVA), we predicted RARP treatment. Results: Of 1,920 patients, 575 (29.9%) underwent RARP and 1,345 (70.1%) ORP. RARP patients had a lower prostate-specific antigen (PSA), and were less likely to harbor pT3b, pathological Gleason ≥4 + 4 or lymph node metastases (all p < 0.05). Pelvic lymph node dissection (PLND) (84.3 vs. 87.0%, p = 0.1), as well as positive surgical margins (15.5 vs. 15.7%, p = 0.7) and the nerve-sparing status (p = 0.5) were comparable between RARP and ORP. Lymph node yield (median 11 vs. 16), and median blood loss (250 vs. 700 ml) were lower at RARP (all p < 0.001). Additionally, the median operating room time was higher at RARP (215 vs. 185 min, p < 0.001). In MVA, patients with body mass index (BMI) ≥30 were more likely to undergo RARP (OR 1.8, 95% CI 1.3-2.4, p < 0.001). Conversely, patients with PSA >20 ng/ml were less likely to undergo RARP (OR 0.6, 95% CI 0.4-1.0, p = 0.03). Conclusions: More favorable pathological characteristics were recorded at RARP. High BMI and low PSA were independent predictors for RARP. Treatment characteristics such as PLND rates, margin status and nerve sparing were comparable between RARP and ORP. Despite lower blood loss at RARP, a longer operating room time and lower yield of lymph nodes were recorded.

Keywords:
Prostate cancer, Robot-assisted radical prostatectomy, Characteristics, Open radical prostatectomy, Pelvic lymph node dissection
1.
Mohler J, Bahnson RR, Boston B, et al: NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw 2010;8:162-200.
2.
Heidenreich A, Bastian PJ, Bellmunt J, et al: EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2014;65:124-137.
3.
Lowrance WT, Eastham JA, Savage C, et al: Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J Urol 2012;187:2087-2092.
4.
Merseburger AS, Herrmann TR, Shariat SF, et al: EAU guidelines on robotic and single-site surgery in urology. Eur Urol 2013;64:277-291.
5.
Trinh QD, Sammon J, Sun M, et al: Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 2012;61:679-685.
6.
Tewari A, Sooriakumaran P, Bloch DA, et al: Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 2012;62:1-15.
7.
Sooriakumaran P, Srivastava A, Shariat SF, et al: A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol 2014;66:450-456.
8.
Bütow Z, Schunk S, Janssen M, et al: Quality of preoperative biopsy is a risk factor for positive surgical margins in organ-confined prostate cancer treated with nerve-sparing robot-assisted radical prostatectomy. Urol Int 2015;95:465-471.
9.
Hu JC, Gu X, Lipsitz SR, et al: Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 2009;302:1557-1564.
10.
Schiffmann J, Haese A, Leyh-Bannurah SR, et al: Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: differences between open and robot-assisted radical prostatectomy. Eur J Surg Oncol 2015;41:1547-1553.
11.
Gandaglia G, Trinh QD, Hu JC, et al: The impact of robot-assisted radical prostatectomy on the use and extent of pelvic lymph node dissection in the ‘post-dissemination' period. Eur J Surg Oncol 2014;40:1080-1086.
12.
Feifer AH, Elkin EB, Lowrance WT, et al: Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy. Cancer 2011;117:3933-3942.
13.
Yee DS, Katz DJ, Godoy G, et al: Extended pelvic lymph node dissection in robotic-assisted radical prostatectomy: surgical technique and initial experience. Urology 2010;75:1199-1204.
14.
Feicke A, Baumgartner M, Talimi S, et al: Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: surgical technique and experience with the first 99 cases. Eur Urol 2009;55:876-883.
15.
Ploussard G, Briganti A, de la Taille A, et al: Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 2014;65:7-16.
16.
Briganti A, Bianchi M, Sun M, et al: Impact of the introduction of a robotic training programme on prostate cancer stage migration at a single tertiary referral centre. BJU Int 2013;111:1222-1230.
17.
D'Amico AV, Whittington R, Malkowicz SB, et al: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969-974.
18.
Schlomm T, Heinzer H, Steuber T, et al: Full functional-length urethral sphincter preservation during radical prostatectomy. Eur Urol 2011;60:320-329.
19.
Budäus L, Isbarn H, Schlomm T, et al: Current technique of open intrafascial nerve-sparing retropubic prostatectomy. Eur Urol 2009;56:317-324.
20.
Steuber T, Heinzer H, Graefen M, et al: Continence and 30 day morbidity of da vinci robotic assisted vs. open prostatectomy in obese men (BMI > = 30) - results from a propensity score matched pair analysis of 230 prostate cancer patients. BJU Int 2012;110:72.
21.
Cooperberg MR, Kane CJ, Cowan JE, et al: Adequacy of lymphadenectomy among men undergoing robot-assisted laparoscopic radical prostatectomy. BJU Int 2010;105:88-92.
22.
Hu JC, Prasad SM, Gu X, et al: Determinants of performing radical prostatectomy pelvic lymph node dissection and the number of lymph nodes removed in elderly men. Urology 2011;77:402-406.
23.
Beyer B, Tennstedt P, Boehm K, et al: PD14-08 amount of dissected lymph nodes during radical prostatectomy does not depend on surgical approach in a single high-volume center. J Urol 2014;191:e413-e414.
24.
Niklas C, Saar M, Berg B, et al: da vinci and open radical prostatectomy: comparison of clinical outcomes and analysis of insurance costs. Urol Int 2015, Epub ahead of print.
25.
Allan C, Ilic D: Laparoscopic versus robotic-assisted radical prostatectomy for the treatment of localised prostate cancer: a systematic review. Urol Int 2015, Epub ahead of print.
26.
Heers H, Laumeier T, Olbert P, et al: Lymphoceles post-radical retropubic prostatectomy: a retrospective evaluation of epidemiology, risk factors and outcome. Urol Int 2015;95:400-405.
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2016
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