Oncology - Prostate
Introduction & Objective : Robot-assisted radical prostatectomy (RARP) has been expanding rapidly in recent years and has become the predominant surgical management for localized prostate cancer in the US. However, there is still a paucity of data on the associations between hospital volume and outcomes of RARP.
Methods : We identified RARPs for clinically localized (cT1-2N0M0) prostate cancer diagnosed between 2010 and 2014 in the National Cancer Database. Hospital volume (cases/year) was defined as the average annual hospital RARP volume over the five-year duration. We categorized hospital volume into very low, low, medium, high, and very high by most closely sorting final included patients into five equal-sized groups (quintiles). Outcomes included 30-day mortality, 90-day mortality, conversion (to open), prolonged length of stay (PLOS, >2 d), 30-day (unplanned) readmission, positive surgical margin (PSM), and lymph node dissection (LND) rates. PSM was analyzed in the overall cohort and intermediate/high-risk cohort and LND was analyzed in the intermediate/high-risk cohort only.
A total of 114,957 patients were included in the final cohort and 75,241 (65%) patients had clinical intermediate/high-risk disease. Cut-off values of hospital volume and crude comparison of outcomes by RARP hospital volumes are shown in the Figure. Overall 30-day mortality (0.12%), 90-day mortality (0.16%), and conversion rate (0.65%) were very low. No difference was found in 30-day or 90-day mortality between the five groups. Multivariable logistic regression results showing the associations between hospital volume and outcomes of RARP are shown in the Table. Higher hospital volume was associated with lower rates of conversion, PLOS, 30-day readmission, and PSM. LND was more often performed for intermediate/high-risk disease in the higher volume hospitals.
Conclusions : Patients undergoing RARP at higher volume hospitals are likely to have better perioperative and oncologic outcomes than lower volume hospitals.