OBJECTIVES

Robot assisted radical prostatectomy (RARP) has been widely adopted worldwide as a standard procedure to treat localized prostate cancer since its introduction in 2000s. In Japan, RARP was rewarded with reimbursement starting in 2012, and approximately 70% of prostatectomies are currently performed with the da Vinci Surgical System (dVSS). In this study, we examined how the use of robot assisted surgery changed over time using real world evidence.

METHODS

We analyzed the historical trend of RARP indications in Japan from 2012 to 2020 using the Medical Data Vision (MDV) claims dataset. The proportions of TNM stage, Age-adjusted Carlson Comorbidity Index (ACCI) scores, smoking index, and age greater than 80 were calculated for every year. We used the Mann-Kendall test to test statistical significance of trend.

RESULTS

The study cohort consisted of 19,257 patients (mean age: 68.2 [SD: 6.01], mean BMI: 23.98 [SD: 5.23]). In 2012, the proportion of T1, T2, and T3 stage patients were 43.43%, 54.55%, and 2.02%, respectively. The average ACCI score and smoking index were 2.66 and 311.37, respectively. We did not identify any patient greater than 80 years old. In 2020, there were 15.21% T1 stage, 68.74% T2 stage, and 15.39% T3 stage patients. The average ACCI score and smoking index were 3.14 and 383.35, respectively. The proportion of the patients greater than 80 years old was 1.06%. From 2012 to 2020, the portions of T3 stage in RARP population increased by 7.6 times. During the same period, ACCI score increased by 0.48. All indications tested significant for trend (p<0.001).

CONCLUSIONS

For the past 8 years, indications of RARP have expanded from mild to more severe cases. This study demonstrates that the Japanese surgeons have been able to take on more complex cases using dVSS in recent years.