Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer

Takashi Kobayashi, Kent Kanao, Motoo Araki, Naoki Terada, Yasuyuki Kobayashi, Atsuro Sawada, Takahiro Inoue, Shin Ebara, Toyohiko Watanabe, Tomomi Kamba, Makoto Sumitomo, Yasutomo Nasu, Osamu Ogawa

Research output: Contribution to journalArticle

Abstract

Background: Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). Methods: We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. Results: Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). Conclusions: Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalInternational Journal of Clinical Oncology
DOIs
Publication statusAccepted/In press - Nov 11 2017

Fingerprint

Robotics
Prostatic Neoplasms
Prostatectomy
Therapeutics
Comorbidity
Watchful Waiting
Androgens
Multicenter Studies
Japan
Radiotherapy
Retrospective Studies
Technology

Keywords

  • Expectant management
  • Patient preference
  • Prostate cancer
  • Robot-assisted radical prostatectomy
  • Treatment choice

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology

Cite this

Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer. / Kobayashi, Takashi; Kanao, Kent; Araki, Motoo; Terada, Naoki; Kobayashi, Yasuyuki; Sawada, Atsuro; Inoue, Takahiro; Ebara, Shin; Watanabe, Toyohiko; Kamba, Tomomi; Sumitomo, Makoto; Nasu, Yasutomo; Ogawa, Osamu.

In: International Journal of Clinical Oncology, 11.11.2017, p. 1-6.

Research output: Contribution to journalArticle

Kobayashi, Takashi ; Kanao, Kent ; Araki, Motoo ; Terada, Naoki ; Kobayashi, Yasuyuki ; Sawada, Atsuro ; Inoue, Takahiro ; Ebara, Shin ; Watanabe, Toyohiko ; Kamba, Tomomi ; Sumitomo, Makoto ; Nasu, Yasutomo ; Ogawa, Osamu. / Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer. In: International Journal of Clinical Oncology. 2017 ; pp. 1-6.
@article{74678a164c10411eb04827962e08b9be,
title = "Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer",
abstract = "Background: Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). Methods: We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. Results: Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70{\%} (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70{\%} of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18{\%}. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15{\%} in 2011 and 12{\%} in 2013 (p = 0.791). Conclusions: Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.",
keywords = "Expectant management, Patient preference, Prostate cancer, Robot-assisted radical prostatectomy, Treatment choice",
author = "Takashi Kobayashi and Kent Kanao and Motoo Araki and Naoki Terada and Yasuyuki Kobayashi and Atsuro Sawada and Takahiro Inoue and Shin Ebara and Toyohiko Watanabe and Tomomi Kamba and Makoto Sumitomo and Yasutomo Nasu and Osamu Ogawa",
year = "2017",
month = "11",
day = "11",
doi = "10.1007/s10147-017-1203-1",
language = "English",
pages = "1--6",
journal = "International Journal of Clinical Oncology",
issn = "1341-9625",
publisher = "Springer Japan",

}

TY - JOUR

T1 - Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer

AU - Kobayashi, Takashi

AU - Kanao, Kent

AU - Araki, Motoo

AU - Terada, Naoki

AU - Kobayashi, Yasuyuki

AU - Sawada, Atsuro

AU - Inoue, Takahiro

AU - Ebara, Shin

AU - Watanabe, Toyohiko

AU - Kamba, Tomomi

AU - Sumitomo, Makoto

AU - Nasu, Yasutomo

AU - Ogawa, Osamu

PY - 2017/11/11

Y1 - 2017/11/11

N2 - Background: Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). Methods: We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. Results: Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). Conclusions: Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

AB - Background: Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). Methods: We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. Results: Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). Conclusions: Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

KW - Expectant management

KW - Patient preference

KW - Prostate cancer

KW - Robot-assisted radical prostatectomy

KW - Treatment choice

UR - http://www.scopus.com/inward/record.url?scp=85033440229&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033440229&partnerID=8YFLogxK

U2 - 10.1007/s10147-017-1203-1

DO - 10.1007/s10147-017-1203-1

M3 - Article

SP - 1

EP - 6

JO - International Journal of Clinical Oncology

JF - International Journal of Clinical Oncology

SN - 1341-9625

ER -