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Robot-Assisted Surgery and Racial and Ethnic Disparities in Post-Prostatectomy Outcomes Among Prostate Cancer Patients

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to determine whether the differences in short-term outcomes between patients undergoing robot-assisted radical prostatectomy (RARP) and those treated with open radical prostatectomy (ORP) differ by race and ethnicity.

Methods

This observational study used New York State Cancer Registry data linked to discharge records and included patients undergoing radical prostatectomy for localized prostate cancer during 2008–2018. We used logistic regression to examine the association between race and ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic), surgical approach (RARP, ORP), and postoperative outcomes (major events, prolonged length of stay [pLOS], 30-day re-admission). We tested interaction between race and ethnicity and surgical approach on multiplicative and additive scales.

Results

The analytical cohort included 18,926 patients (NHW 14,215 [75.1%], NHB 3195 [16.9%], Hispanic 1516 [8.0%]). The average age was 60.4 years (standard deviation 7.1). NHB and Hispanic patients had lower utilization of RARP and higher risks of postoperative adverse events than NHW patients. NHW, NHB, and Hispanic patients all had reduced risks of adverse events when undergoing RARP versus ORP. The absolute reductions in the risks of major events and pLOS following RARP versus ORP were larger among NHB {relative excess risk due to interaction (RERI): major events −0.32 [95% confidence interval (CI) −0.71 to −0.03]; pLOS −0.63 [95% CI −0.98 to −0.35]) and Hispanic (RERI major events −0.27 [95% CI −0.77 to 0.09]; pLOS −0.93 [95% CI −1.46 to −0.51]) patients than among NHW patients. The interaction was absent on the multiplicative scale.

Conclusions

RARP use has not penetrated and benefited all racial and ethnic groups equally. Increasing utilization of RARP among NHB and Hispanic patients may help reduce disparities in patient outcomes after radical prostatectomy.

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Data Availability

Data used in this study are subject to a data use agreement (DUA) between NYSDOH and Weill Cornell Medical College, and thus cannot be shared publicly. Investigators interested in the data should work with New York State to establish DUAs.

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Funding

This study was partially supported by the Dean’s Diversity and Healthcare Disparity Research Awards of Weill Cornell Medicine (Principal Investigator: Jialin Mao).

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA

    Jialin Mao MD, PhD

  2. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Jialin Mao MD, PhD, Jeanine M. Genkinger PhD, MHS, Andrew G. Rundle DrPH & Parisa Tehranifar DrPH

  3. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA

    Jeanine M. Genkinger PhD, MHS & Parisa Tehranifar DrPH

  4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Jason D. Wright MD

  5. New York State Cancer Registry, New York State Department of Health, Albany, NY, USA

    Maria J. Schymura PhD & Tabassum Z. Insaf MBBS, PhD

  6. Department of Urology, Weill Cornell Medicine, New York, NY, USA

    Jim C. Hu MD, MPH

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  1. Jialin Mao MD, PhD
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  2. Jeanine M. Genkinger PhD, MHS
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Corresponding author

Correspondence to Jialin Mao MD, PhD.

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Disclosures

Jason D. Wright has received research funding from Merck and honoraria from UpToDate. Jim C. Hu declares he was a consultant for Intuitive Surgical and Pfizer. Health Research, Inc., where Maria J. Schymura is an employee, received a standard fee for conducting a linkage between discharge records and cancer registry records, however this does not constitute a relevant conflict of interest. Jialin Mao, Jeanine M. Genkinger, Andrew G. Rundle, Tabassum Z. Insaf, and Parisa Tehranifar have no conflicts of interest to declare

Human or Animal Participant

This study was determined as exempt by the Weill Cornell Medicine Institutional Review Board.

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Mao, J., Genkinger, J.M., Rundle, A.G. et al. Robot-Assisted Surgery and Racial and Ethnic Disparities in Post-Prostatectomy Outcomes Among Prostate Cancer Patients. Ann Surg Oncol 31, 1373–1383 (2024). https://doi.org/10.1245/s10434-023-14447-7

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