Robotic radical prostatectomy: a critical analysis of surgical quality

To review the ways in which the quality of radical prostatectomy and robot-assisted radical prostatectomy have been assessed, including quality-of-life (QoL) assessment, combined outcomes reporting, and patient utilities.

Superlative survival expectations following radical prostatectomy have shifted the paradigm of assessing surgical quality toward the prospective evaluation of QoL outcomes and combined outcomes reporting. Several high quality multi-institutional studies have compared QoL outcomes between the common treatment modalities for prostate cancer. Single-institution combined outcomes 'Trifecta' studies provide a convenient presentation of outcomes most important to the surgeon but have many associated limitations. The assessment of patient preferences for treatment outcomes is an underexplored area within the urologic literature and can provide an insight into a patient's perception of surgical quality as seen in a pilot study performed at our institution.

Advances in the use of validated QoL instruments allow patients and clinicians to select treatment based on the perceived risk of adverse QoL impact but do not provide an insight into what the individual patient considers important. Combined outcomes reports also fail to address key patient concerns. A phenomenologic assessment of robot-assisted radical prostatectomy surgical quality does not exist, but will be necessary to properly evaluate surgical quality.