Comparison and trend of perioperative outcomes between robot-assisted radical prostatectomy and open radical prostatectomy: nationwide inpatient sample 2009-2014

ABSTRACT Purpose: To make a further evaluation of perioperative outcomes between the robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we conducted a comparison and trend analysis by using the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Materials and Methods: Adult prostate cancer patients with radical prostatectomy were abstracted from the NIS. RARP and ORP were identified according to the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes. The perioperative outcomes included blood transfusion, intraoperative and postoperative complications, prolonged length of stay (pLOS), and in-hospital mortality. Propensity score matching method and multivariable logistic regression model were performed to adjust for the pre-defined covariates. The annual percent change (APC) was used to detect the change trend of rates for outcomes. Results: A total of 77.054 patients were included in our study. According to the results of propensity score matching analyses, RARP outperformed ORP in blood transfusion (1.96% vs. 9.40%), intraoperative complication (0.73% vs. 1.25%), overall postoperative complications (8.87% vs. 11.97%), and pLOS (13.39% vs. 36.70%). We also found that there was a significant decreasing tendency of incidence in blood transfusion (APC=-9.81), intraoperative complication (APC=-12.84), and miscellaneous surgical complications (APC=-14.09) for the RARP group. The results of multivariable analyses were almost consistent with those of propensity score matching analyses. Conclusions: The RARP approach has lower incidence rates of perioperative complications than the ORP approach, and there is a potential decreasing tendency of complication incidence rates for the RARP.

Effectiveness of radiofrequency ablation therapy for patients with unresected Stage IA non-small cell lung cancer

Background: Approximately 20% of patients with resectable non-small cell lung cancer (NSCLC) are treated nonsurgically. To compare the clinical outcomes between nonsurgical patients receiving radiofrequency ablation (RFA) alone and those receiving no treatment (NT), we assessed RFA effectiveness in terms of survival using the surveillance, epidemiology, and end-results (SEER) database. Methods: Using the SEER registry process, we identified 5268 patients who were ineligible for the surgical treatment between 2004 and 2015. Overall survival (OS) and cancer-specific survival (CSS) were compared between the groups using propensity score matching (PSM), inverse probability of treatment weight (IPTW), and overlap weight analysis. In addition, an exploratory analysis was conducted to determine RFA treatment effectiveness based on clinically relevant patient subsets. Results: Of the 5268 patients, 189 (3.6%) received RFA. The OS and CSS in these patients were significantly better than those in the NT group (P < 0.0001). RFA was associated with a 16-month median OS improvement. Both OS and CSS improved in the nonsurgical patients (hazard ratio [HR], 0.695, 95% confidence interval [CI], 0.585–0.826, P < 0.0001; HR, 0.636; 95% CI, 0.505–0.800, P < 0.0001). The 1-, 3-, and 5-year OS in the unmatched RFA and NT groups were 84.2%, 49.0%, and 29.4% vs. 62.8%, 31.1%, and 17.1%, respectively (P < 0.001). PSM, IPTW, and overlap weight analysis showed comparable results. The odds of receiving RFA decreased with larger tumor size (>1, ≤2 cm, odds ratio [OR], 0.623, 95% CI, 0.402–0.966; >2, ≤3 cm, OR, 0.300, 95% CI, 0.186–0.483) compared to tumor size s1 cm (P < 0.05). Conclusion: RFA improves unresected stage IA NSCLC patient survival. Our results are limited by the retrospective nature of the study; however, we believe that our findings are noteworthy for recommending local ablative therapy