Perioperative and oncologic outcomes with robotic vs. open radical prostatectomy

A population-based study in Ontario, Canada

Authors

  • Amanda E. Hird Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
  • Rano Matta Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
  • Sarah Neu Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
  • Janine Xu Ontario Health, Toronto, Ontario, Canada
  • Tharsiya Martin Ontario Health, Toronto, Ontario, Canada
  • Amber Hunter Ontario Health, Toronto, Ontario, Canada
  • Girish S. Kulkarni Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Paul Karanicolas Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • Natalie Coburn Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • Robert K. Nam Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
  • Sender Herschorn Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
  • Frances C. Wright Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

DOI:

https://doi.org/10.5489/cuaj.9708

Keywords:

Prostate cancer, Robotic surgery, Radical prostatectomy, Oncologic, Functional and Complications Outcomes

Abstract

Introduction: Robotic-assisted radical prostatectomy (RARP) is the predominant surgical treatment for localized prostate cancer worldwide, but adoption has been slower in Ontario due to funding constraints. This setting enables population-level comparison of RARP and open radical prostatectomy (ORP). We evaluated perioperative and short-term oncologic outcomes for men undergoing radical prostatectomy in Ontario between April 2017 and March 2024.

Methods: We conducted a retrospective cohort study of all patients who underwent publicly funded radical prostatectomy for localized prostate cancer. Co-primary outcomes were blood transfusion rates and hospital length of stay (LOS). Secondary outcomes included operative time, 30-day readmission, vesico-urethral anastomosis stenosis (VUAS) requiring intervention, surgical wait time, and travel distance. Exploratory outcomes included 30-day mortality, positive surgical margins (PSM), and receipt of pelvic radiation post-prostatectomy.

Results: Among 15 073 patients, 6645 (44.1%) underwent RARP and 8428 (55.9%) ORP. Median followup was 36.8 months after RARP and 38.8 months after ORP. RARP was associated with lower transfusion rates (1.2% vs. 4.7%, p<0.001), shorter LOS (median 1.0 vs 2.0 days, p<0.0001), fewer 30-day readmissions (23.6% vs. 26.1%, p=0.0005), and markedly fewer VUAS interventions (1.2% vs. 12.0%, p<0.0001). RARP had longer adjusted operative time (+60 minutes, p<0.001), longer waits, and greater travel distance. PSM (31.0% vs. 38.2%, odds ratio 0.72, p<0.001) and need for post-prostatectomy radiotherapy (20.9% vs. 29.5%, hazard ratio 0.65, p<0.0001) were lower with RARP.

Conclusions: In Ontario, RARP demonstrated superior perioperative outcomes, lower VUAS, and improved oncologic indicators compared with ORP. As access expands, balancing quality, equity, and timeliness will be essential, alongside further study of cost implications.

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Published

2026-10-19

How to Cite

Hird, A. E., Matta, R., Neu, S., Xu, J., Martin, T., Hunter, A., … Wright, F. C. (2026). Perioperative and oncologic outcomes with robotic vs. open radical prostatectomy: A population-based study in Ontario, Canada . Canadian Urological Association Journal, 21(2). https://doi.org/10.5489/cuaj.9708

Issue

Vol. 21 No. 2 (2027): CUAJ February

Section

Original Research

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