Trends in Medical Traveling for Radical Prostatectomy in the Era of Robotic Surgery A Nationwide Cohort Study in Korea

Abstract

Purpose: This study evaluated the trends in medical travel for radical prostatectomy (RP) in Korea during the robotic surgery era over a 10-year period. Regional self-sufficiency rates (SSR) for RP were analyzed, and factors associated with medical travel were identified. Materials and Methods: We retrospectively analyzed nationwide claims data from 2009 to 2019. Among 161,385 men newly diagnosed with prostate cancer, 57,096 (35.4%) underwent RP, including 6,482 laparoscopic RP (LRP), 16,092 open RP (ORP), and 34,522 robot-assisted RP (RARP). The regional SSR was defined as the proportion of patients undergoing RP within the same region of diagnosis, whereas medical travel was defined as RP performed outside the region of diagnosis. Logistic regression analysis was used to identify the factors associated with medical travel, and SSR trends were assessed using chi-square trend analysis. Results: In 2009, 2,983 RPs (ORP: 1,163, LRP: 358, RARP: 1,462) were performed, increasing to 8,332 (ORP: 1,449, LRP: 670, RARP: 6,213) by 2019. The proportion of patients who underwent RARP increased from 49% to 75%. Nationwide SSR for overall RP showed a significant increasing trend (chi(2)(trend)=73.413, p(trend)<0.001). Non-Seoul regions exhibited a significant upward trend (chi(2)(trend)=7.19, p(trend)=0.007), whereas Seoul showed no significant trend (chi(2)(trend)=1.905, p(trend)=0.168). Non-Seoul SSR for RARP demonstrated the most pronounced growth (chi(2)(trend)=156.085, p(trend)<0.001). However, nationwide SSR for RARP showed no significant increasing trend (chi(2)(trend)=1.888, p(trend)=0.169). Younger age, lower Charlson comorbidity index score, non-Seoul residence, and preference for robotic surgery were associated with medical travel. Conclusions: The proportion of RARPs steadily increased with the expansion of robotic surgical systems for prostate cancer in Korea. Despite improvements in the SSR for RARP in non-Seoul regions, disparities remain, with Seoul being the primary location for robotic surgery.