Patient-reported Functional Outcomes Following Open, Laparoscopic, and Robotic Assisted Radical Prostatectomy Performed by High-volume Surgeons at High-volume Hospitals

Background: Functional outcomes following radical prostatectomy (RP) have received increased focus with dissemination of minimally invasive approaches. Objective: To examine contemporary patient-reported functional outcomes following open RP. (ORP), laparoscopic RP, (LRP), and robotic assisted RP (RARP) performed by high-volume surgeons at high-volume hospitals. Design, settings, and participants: This was a retrospective cohort study of 1686 men with cT1-cT2 prostate cancer treated with ORP (n = 441), LRP (n = 156), or RARP (n = 1089) by high-volume surgeons (annual volume ≥25 cases) at two academic centers from 2009 to 2012. Surveys containing the Expanded Prostate Cancer Index Composite urinary and sexual domains were administered at a median of 30.5 mo postoperatively. Interventions: ORP, LRP, and RARP. Outcome measurements and statistical analysis: Bother with overall urinary and sexual function was examined and stratified by surgical technique. Logistic regression models evaluated the associations of clinicopathologic features with survey responses. Results and limitations: In total, 6.4% of men reported a moderate or big problem with overall urinary function (ORP 5.8%, LRP 5.1%, RARP 6.8%; p = 0.62), whereas 37.3% reported a moderate or big problem with overall sexual function (ORP 37.2%, LRP 36.1%, RARP 37.5%; p = 0.95). On multivariable analysis, older age at surgery (odds ratio [OR]: 1.08; p < 0.0001) was associated with overall urinary bother, whereas older age at surgery (OR: 1.03; p = 0.005), preoperative erectile dysfunction treatment (OR: 2.22; p < 0.0001), greater prostate volume (OR: 1.01; p = 0.02), and RP Gleason score (7 vs 6: OR: 0.96; p = 0.004; 8-10 vs 6: OR: 2.25; p = 0.0006) were associated with overall sexual bother. Surgical technique was not associated with either functional outcome. Limitations included selection bias and a retrospective design. Conclusions: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent functional outcomes independent of surgical technique. These results have implications for patient counseling. Patient summary: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent outcomes for urinary and sexual function following radical prostatectomy regardless of surgical technique. In this study of high-volume surgeons at high-volume hospitals, patients reported excellent outcomes for overall urinary and sexual function following radical prostatectomy. Surgical technique was not associated with either functional outcome. Limitations included selection bias and a retrospective design. Conclusions: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent functional outcomes independent of surgical technique. These results have implications for patient counseling. Patient summary: In this study of high-volume surgeons at high-volume hospitals, patients reported excellent outcomes for urinary and sexual function following radical prostatectomy regardless of surgical technique.