Robot assisted surgery has been touted as offering superior outcomes in various oncological surgeries. We sought to evaluate the comparative effectiveness of robotic radical nephrectomy (RRN) compared to laparoscopic radical nephrectomy (LRN) in regards to hospital charges, complications, and survival.
Using the Surveillance Epidemiology and End Results (SEER) Program-Medicare linked database, we identified patients over the age of 65 who underwent radical nephrectomy for non-metastatic renal cell carcinoma from 2008 to 2012. Patients who underwent RRN were compared to those who underwent LRN. We used propensity scoring matching to compare perioperative and survival outcomes, including overall survival, cancer-specific survival, major adverse events, and healthcare charges.
241 patients underwent RRN and 574 patients underwent LRN. After propensity score matching, the adverse events rate and length of stay were similar between two groups (Major Events: 5.7% vs 6.1%, p=0.84; prolonged LOS: 17.8% vs 16.1%, p=0.62). The inpatient charges following RRN were significantly higher than those of LRN ($53,681 vs. $44,161, p<0.01). The mean follow up of the cohort was 3.2 years. Estimated overall survival (88.0% vs. 87.9%, p=0.90) and cancer-specific survival (98.1% vs. 96.4%, p=0.25) were similar between the two matched cohorts at three years.
The robotic platform showed no benefit over standard laparoscopy for radical nephrectomy, as we found no difference in oncologic efficacy or adverse event rates.
Journal of endourology. 2016 Nov 03 [Epub ahead of print]
David M Golombos, Bilal Chughtai, Quoc-Dien Trinh, Jialin Mao, Alexis E Te, Padraic O'Malley, Douglas Scherr, Joseph Del Pizzo, Jim C Hu, Art Sedrakyan
NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 159947, Urology , 535 East 68th Street , Starr 900 , New York, New York, United States , 10065 ; ., Weill Cornell Medical Center, Urology , 425 East 61st Street , 12th Floor , new york, New York, United States , 10065 ; ., Brigham and Women's Hospital, 1861, Boston, Massachusetts, United States ; ., Weill Cornell Medical College , 402 E 67th St , New York, New York, United States , 10065 ; ., Cornell Univ Med Ctr, Urology , 1300 York Ave, F9W, Box 261 , New York, New York, United States , 10021 ; ., Dalhousie University Faculty of Medicine, 12361, Halifax, Nova Scotia, Canada ; ., Joan and Sanford I Weill Medical College of Cornell University, 12295, New York, New York, United States ; ., Cornell Univ Med Ctr , 400 E 59th Street , Starr 900 , New York, New York, United States , 10021 ; ., Joan and Sanford I Weill Medical College of Cornell University, 12295, New York, New York, United States ; ., New York, New York, United States ; .