The impact of robotic surgery on the surgical management of prostate cancer in the USA
Menée à partir de données portant sur 489 369 patients atteints d'un cancer de la prostate traité entre 2003 et 2010, cette étude américaine analyse l'évolution de l'utilisation de la prostatectomie radicale assistée par robot, puis évalue son impact sur l'organisation et les coûts de la prise en charge chirurgicale des patients
Objective : To describe the surgeon characteristics associated with robot-assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost. Patients and Methods : A retrospective cohort study with a weighted sample size of 489 369 men who underwent non-RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures. Results : From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High-volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7–3.4), intermediate- (200–399 beds; OR 5.96, 95% CI 1.3–26.5) and large-sized hospitals (≥400 beds; OR 6.1, 95% CI 1.4–25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7–6.4). RARP adoption was generally associated with increased RP volume, greatest for high-volume surgeons and least for low-volume surgeons (<5 RPs annually). The annual number of surgeons performing RP decreased from about 10 000 to 8200, with the proportion of cases performed by high-volume surgeons increasing from 10% to 45%. RARP was more costly, disproportionally contributing to the 40% increase in annual prostate cancer surgery expenditures. RARP costs generally decreased plateauing at slightly over $10 000, while non-RARP costs increased to nearly $9000 by the end of the study. Conclusion : There was widespread RARP adoption in the USA between 2003 and 2010, particularly among high-volume surgeons. The diffusion of RARP was associated with a centralisation of care and an increased economic burden for prostate cancer surgery.