Abstract and Introduction
Abstract
Background: Radical prostatectomy is the standard of care in patients with prostate cancer. Robot-assisted prostatectomy have been used as alternatives to open surgery as they result in less bleeding and allow patients to return to normal activities sooner. This study sought to evaluate the medical factors and health economics of robot-assisted and laparoscopic-assisted prostate cancer surgery to provide a valuable reference for clinicians, patients, and their families when selecting a surgical method for prostate cancer.
Methods: Patients treated with Da Vinci robot-assisted surgery (DVRS) or laparoscopic-assisted surgery (LS) between January 1, 2019, and June 1, 2021, were included in this retrospective analysis. The general baseline data included age, height, weight, body mass index (BMI), preoperative total prostate specific antigen (TPSA), Gleason score, tumor stage, operation time, intraoperative blood loss volume, hospital stay, drainage volume within 24 hours postoperatively, extubation time, postoperative hospital stay, and detailed hospitalization expenditure. The medical and health economics factors were compared between the two prostatectomy techniques.
Results: The preoperative characteristics of the patients in the DVRS group and LS group were comparable, and the differences were not statistically significant (all P>0.05). Compared to the LS group, the operation time was significantly longer in the DVRS group, whereas the volume of intraoperative blood loss, hospital stay, extubation time, and postoperative hospital stay were all markedly lower (all P<0.05). Also, the treatment, nursing, and total operation costs were considerably lower in the DVRS group compared to the LS group, while the medical material cost, total hospitalization cost, and personal expenses were all notably higher (all P<0.05).
Conclusions: Da Vinci robot-assisted prostatectomy is safe; however, the health economics should not be neglected that the robot-assisted operation cannot completely replace the conventional laparoscopic operation in the short term. The consideration of both clinical efficacy and health economics is necessary to provide suggestions for the choice of modus operandi.
Introduction
Prostate cancer is a prominent disease affecting the health of men worldwide, accounting for 14.1% of all new cancer diagnoses and 6.8% of all cancer deaths in men in 2020.[1] At the time of diagnosis, 78.2% of the patients are in a clinically localized stage, and the 5-year survival for localized prostate cancer is 100%.[2] Radical prostatectomy is the standard of care in patients with localized disease and the life expectancy is >10 years.[3]
Radical prostatectomy can be performed via open, laparoscopic-assisted, or robot-assisted surgery. Recently, conventional laparoscopic-assisted prostatectomy and robot-assisted prostatectomy have been used as alternatives to open surgery because they result in less bleeding and allow patients to return to normal activities sooner.[4–6] However, the high cost of robotic technology had led numerous authorities to question its value to patients and healthcare providers. Meanwhile, the conventional laparoscopic-assisted method continues to be practiced in most medical centers in China.[7]
To determine whether the additional costs of robot-assisted prostatectomy can be offset by its potential to provide rapid recovery and better outcomes, we performed this retrospective study to compare the medical safety, hospitalization index, and economic costs between the laparoscopic-assisted and robot-assisted prostatectomy techniques. The findings of this study can provide useful evidence that could help to promote clinical decision-making based on the health economics and management of Da Vinci robot-assisted surgery (DVRS) for the treatment of prostate cancer, contribute to therapeutic standardization, and provide further suggestions for the application of DVRSs. Moreover, the data presented in this study could be used as a valuable reference by clinicians, patients, and their families when selecting a surgical method for prostate cancer. We present the following article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-22-739/rc).
Transl Androl Urol. 2022;11(12):1729-1734. © 2022 AME Publishing Company
