Robot-assisted radical prostatectomy in the Korean population: A 5-year propensity-score matched comparative analysis versus open radical prostatectomy

Objectives: To compare the oncological outcomes of robot-assisted laparoscopic radical prostatectomy with those of open radical prostatectomy in contemporary Korean prostate cancer patients. Methods: From a group of 1172 patients consisting of 592 (50.5%) robot-assisted laparoscopic radical prostatectomy and 580 (49.5%) open radical prostatectomy cases carried out between 1992 and 2008, 175 robot-assisted laparoscopic radical prostatectomy cases were matched with an equal number of open radical prostatectomy cases by propensity scoring based on patient age, preoperative prostate-specific antigen, biopsy Gleason score and clinical tumor stage. Competing-risks survival analyses were used to evaluate oncological outcomes, including rates of positive surgical margin, biochemical-recurrence, adjuvant therapy, cancer-specific survival, overall survival and metastasis-free survival during the mean follow up of 58.4months. Results: Positive surgical margin rates were comparable between robot-assisted laparoscopic radical prostatectomy and open radical prostatectomy cohorts (19.4% vs 21.8%), with comparable rates for all pathological stages and risk subgroups. Positive surgical margin rates according to location were comparable, with the apical margin being the most common location. Robot-assisted laparoscopic radical prostatectomy recovered higher lymph node yields compared with open radical prostatectomy (12.5 vs 3.8; P<0.001). The robot-assisted laparoscopic radical prostatectomy and the open radical prostatectomy groups showed equal oncological outcomes regarding 5-year biochemical recurrence-free survival (log-rank P=0.651), metastasis-free survival (log-rank P=0.876), cancer-specific survival (log-rank P=0.076) and overall survival (log-rank P=0.648), respectively. Between groups, there was no difference in the rate of adjuvant therapy, time to first adjuvant therapy failure or in the rate of subsequent secondary treatment. Conclusions: Robot-assisted laparoscopic radical prostatectomy represents an effective surgical approach for the treatment of prostate cancer in the Korean population, as it provides equivalent oncological outcomes to open radical prostatectomy.