Return to work following robot-assisted laparoscopic and open retropubic radical prostatectomy: A single-center cohort study to compare duration of sick leave

Highlights

• The duration of sick leave after radical prostatectomy does not depend on the surgical approach.

• Physical workload and monthly revenue highly influence the duration of sick leave.

• Freelancers return to work earlier than patients in salaried position.

• Results apply for a large cohort operated at a German high-volume prostate cancer center.

• Six weeks of sick leave after radical prostatectomy appear realistic.

Abstract

Purpose

To compare the duration of sick leave in patients with localized prostate cancer after robot-assisted radical prostatectomy (RARP) and open retropubic RP (ORP) at a German high-volume prostate cancer center.

Methods

The data of 1,415 patients treated with RP at Martini Klinik, Prostate Cancer Center between 2012 and 2016 were, retrospectively, analyzed. Information on employment status, monthly revenues and days of work missed due to sickness were assessed via online questionnaire. Additional data were retrieved from our institutional database.

Medians and interquartile ranges (IQR) were reported for continuous data. Cox proportional hazard analysis was performed to compare both surgical techniques for return to work time after RP.

Results

Median time elapsed between surgery and return to work comprised 42 days in patients undergoing RARP (IQR: 21–70) and ORP (IQR: 28–84, P = 0.05). In Cox regression analysis, surgical approach showed no impact on return to work time (RARP vs. ORP hazard ratio = 1, 95% CI: 0.91–1.16, P = 0.69). Return to work time was significantly associated with employment status, physical workload and monthly income (all P<0.001). Limitation of this study is the nonrandomized design in a single-center.

Conclusions

As the surgical approach did not show any influence on the number of days missed from work in patients undergoing RP, no superiority of either RARP or ORP could be identified for return to work time in a German cohort. Both surgical approaches are safe options usually allowing the patients to resume normal activities including work after an appropriate convalescence period.

Introduction

Prostate cancer (PCa) continues to be the most common malignancy of male and the third most common cancer related cause of death in men worldwide [1]. The widespread use of prostate specific antigen-based screening lead to the detection of tumors in early stages resulting in an increasing number of men in working age diagnosed with (PCa) [2], [3].

PCa and its treatment leads to severe consequences for the patient’s working abilities; men undergoing radical prostatectomy (RP) were found less likely to remain employed after 6 months compared to healthy individuals [4], [5]. Time lost from work due to sickness is not only relevant under socioeconomic aspects. Work provides structure and satisfaction to a good part of men and gives a sense of belonging. Losing their working abilities, many individuals face a feeling of uselessness and a lack of identity [6].

The ideal treatment for PCa should, therefore, combine oncological safety and favorable functional outcomes followed by a quick recovery process, enabling the patients to resume their daily activities including work as soon as possible.

Recommended treatments for organ-confined nonmetastatic PCa are radical prostatectomy, radiation therapy and active surveillance [7]. Within the past decade, RARP has been widely adopted as a standard procedure for the treatment of PCa reaching from 30% in our institution in 2013 [8] until up to 70% to 90% in centers in Scandinavia or the United States [5], [9].

At our institution, the minimally invasive robotic approach is performed placing 5 or 6 trocars plus a supraumbilical minilaparotomy to remove the organ. The open approach demands a median suprapubic laparotomy measuring 10 to 12 cm. RARP thus involves some short-term advantages such as reduced bleeding, decreased need in postoperative analgesics and shorter length of stay in hospital [8], [10], [11], [12] but it remains unclear if these advantages lead to a faster recovery process.

Based upon the lower level of invasiveness of the robotic approach we hypothesized shorter durations of sick leave in patients undergoing RARP compared to patients after ORP.