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  • br is unlikely in the near

    2022-05-06


    267 is unlikely in the near future. In consequence, retrospective data from large population-based data
    268 repositories will provide the most robust and generalizable evidence for robotically-assisted relative
    269 to open CRP. Additionally, it should be noted that the definition of CRP is not standardized and the
    270 definition of mPCa patients undergoing CRP through coding ICD might be inaccurate and
    272 Beside its retrospective nature, our study also suffers of several other limitations that are
    273 inherent to population-based analyses. For example, we were unable to adjust for tumor
    274 characteristics. It could be argued that open CRP patients harbored more advanced prostate cancer
    275 stages, which could adversely affect intraoperative and postoperative complication rates. In
    276 consequence, adjustment for tumor stage, AMG 925 node metastases, as well as lymph node dissection
    277 extent, which might have been more extensive in open CRP patients, could have influenced the
    278 complication rates. Moreover, we were also unable to adjust for patient characteristics, such as
    279 performance status, American Society of Anesthesiologists status, differences in laboratory values
    280 and opioid use, as well as presence or absence of exposure to neoadjuvant chemotherapy, androgen 13
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    281 deprivation and radiotherapy. This said, despite multivariable adjustments are residual selection
    282 bias may have cofounded our results. Moreover, ideally a grading system for complications, such as
    283 the Clavien-Dindo system, should be used when surgical outcomes are observed 25. However, this
    284 information is unavailable in large data repositories such as the NIS. Finally, only inpatients
    285 information’s were available in the database we analyzed and no data were available regarding
    286 readmissions and late complications 17. Last but not least, it should be underlined that our study is
    287 not able to provide any information regarding the oncologic outcomes of open vs. robot assisted
    288 CRP, as well as that no information on positive surgical margins and data on surgeons’ experience
    289 is available within the NIS.
    293 In conclusion, the intraoperative and postoperative complications associated with robotically-
    294 assisted CRP are lower than Release (termination) factors of open CRP. Similarly, robotically-assisted CRP is associated
    295 with shorter stay. Conversely, an increase in total hospital charges is associated with robotically-
    296 assisted CRP. Nonetheless, robotically-assisted CRP complication profile validates its safety and
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    298 Clinical practice points
    299 · Intraoperative and postoperative complications associated with robotically-assisted CRP
    300 are lower than those of open CRP.
    301 · Robotically-assisted CRP is associated with shorter stay.
    302 · Total hospital charges associated with robotically-assisted CRP are higher compared to
    304 · Nonetheless, CRP despite its feasibility does not represent the standard of care for newly
    305 diagnosed prostate cancer patients.
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    309 References
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    prostate cancer and low volume skeletal metastases: results of a feasibility and case-control 313
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    Impact on Prognosis in Prostate Cancer Patients with Low-volume Bone Metastasis? Results 331
    from a Prospective Case-Control Study. Eur Urol Focus. 2017. 332 9. Trinh QD, Sammon J, Sun M, et al. Perioperative outcomes of robot-assisted radical 333
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    1426. 340 12. Sooriakumaran P, Karnes J, Stief C, et al. A Multi-institutional Analysis of Perioperative 341
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    following open radical cystectomy versus robot-assisted laparoscopic radical cystectomy: 354
    Radical Prostatectomy Compared With Open Radical Prostatectomy. Clin Genitourin