Midterm oncologic outcomes after robotic-assisted laparoscopic radical prostatectomy.

Abstract

e16084 Background: The robotic surgery has been extensively adopted in many surgical areas, especially in Urology. It's proven benefits (less blood loss, shorter recovery and reduced complication rates) has made it the most popular method to perform a radical prostatectomy nowadays. However, scarce data exists on the long-term oncologic outcome of robotic assisted laparoscopic prostatectomy (RALP). Since 2003, over 3,000 RALPs have been performed at our institution. We report the midterm oncologic outcome data of 1,054 patients with a median follow up of 60 months after RALP. Methods: From March 2003 to August 2008, 1,054 patients underwent RALP. Prospectively attained clinical data has been stored in an IRB approved database. Follow up has been maintained every 6 months for 2 years, and yearly thereafter. Salvage RALPs were excluded. Biochemical recurrence (BCR) defined as PSA > 0.2ng/ml, disease free survival, cancer specific and overall survival were assessed. Results: Of the 1,054 patients within the database, 1,019 met the criteria for evaluation. Mean age was 60 years (IQR 55-65), and mean BMI 27 kg/m2 (IQR 25-30). 181 patiemts (17.3%) were African Americans. Pre-operative mean PSA was 5.3 ng/ml (IQR 4.2-7.4). The majority of patient's clinical stage was T1c [ 776 (73.6%)] while 278 were T2. Biopsy Gleason score (GS) was 6, 7, and ≥8, in 666 (63.2%), 324 (30.7%), and 64 patients (6.1%), respectively. 298 patients underwent a bilateral pelvic lymph node dissection (28.3%). Pathologic GS was 6, 7 and ≥8, in 563 (53.5%), 431 (41%), and 58 patients (5.5%), respectively. The pathological tumor stage was T2 in 834 (79.3%), T3a in 164 (15.6%) and T3b in 54 (5.1%). 14 patients (1.3%) had nodal involvement. Positive surgical margins occurred in 205 cases (20%). BCR occurred in 123 patients (12%). 2 deaths due to prostate cancer (0.2%) and 7 due to other causes (0.7%). Cancer specific survival is thus 99.1% at the mean follow up (60months) by Kaplan Meier analysis. Conclusions: Our midterm oncologic outcomes are consistent with those previously reported in open radical prostatectomy series. Ongoing, long term follow up is necessary in order to solidify it's role in prostate cancer managment.