MP62-08 SIGNIFICANT REDUCTION IN POSITIVE SURGICAL MARGINS AND BIOCHEMICAL RECURRENCE RISK AT 2 YEARS NOTED EARLIER FOR ROBOTIC PROSTATECTOMY: COMPREHENSIVE EVALUATION AND CUSUM ANALYSIS OF ONCOLOGICAL OUTCOMES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 2015MP62-08 SIGNIFICANT REDUCTION IN POSITIVE SURGICAL MARGINS AND BIOCHEMICAL RECURRENCE RISK AT 2 YEARS NOTED EARLIER FOR ROBOTIC PROSTATECTOMY: COMPREHENSIVE EVALUATION AND CUSUM ANALYSIS OF ONCOLOGICAL OUTCOMES Arjun Sivaraman, Rafael Sanchez Salas, Dominique Prapotnich, Fabien Olivier, Kaixin Yu, Christian Doudeau, Stéphane David, Eric Barret, Fernando P. Secin, Alexandre Ingels, Francois Rozet, Marc Galiano, Annick Mombet, Nathalia Cathala, and Xavier Cathelineau Arjun SivaramanArjun Sivaraman More articles by this author , Rafael Sanchez SalasRafael Sanchez Salas More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , Fabien OlivierFabien Olivier More articles by this author , Kaixin YuKaixin Yu More articles by this author , Christian DoudeauChristian Doudeau More articles by this author , Stéphane DavidStéphane David More articles by this author , Eric BarretEric Barret More articles by this author , Fernando P. SecinFernando P. Secin More articles by this author , Alexandre IngelsAlexandre Ingels More articles by this author , Francois RozetFrancois Rozet More articles by this author , Marc GalianoMarc Galiano More articles by this author , Annick MombetAnnick Mombet More articles by this author , Nathalia CathalaNathalia Cathala More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2382AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The primary objective was to evaluate the learning curve of Minimally Invasive Radical Prostatectomy (MIRP) in our institution and apply the cumulative summation (CUSUM) analytical technique to identify salient learning curve transition points in terms of oncological outcomes. METHODS Clinical, pathologic, and oncological outcome data were collected from our prospectively collected MIRP database to estimate Positive Surgical margin (PSM) and Biochemical Recurrence (BCR) trends during a 15 year period from 1998 to 2013. All the RPs (laparoscopic (LRP) / Robotic Assisted [RARP]) were performed by 9 surgeons. PSM was defined as presence of cancer cells at inked margins. BCR was defined as serum Prostate Specific Antigen (PSA) >0.2 ng/ml and rising or start of secondary therapy. Surgical learning curve was assessed with the application of Kaplan-Meier curves, Cox regression model, CUSUM and logistic model in order to define the “transition point” of surgical improvement. RESULTS We identified 5547 patients with localized prostate cancer treated with MIRP (3846 - LRP and 1701 – RARP). Patient characteristics of LRP and RARP were similar. The overall risk of PSM in LRP was 25%, 20% and 17% for the first 50, 50 to 350 and >350 cases, respectively. For the same population, the 5-year BCR rate decreased from 21.5% to 16.7%. RARP started 3 years after the LRP program (after approximately 250 LRP). The PSM rate for RARP decreased from 21.8% to 20.4% and the corresponding 5-year BCR rate decreased from 17.6% to 7.9%. The CUSUM analysis showed significantly lower PSM and BCR at 2 years occurred at the transition point of 350 cases for LRP and 100 cases for RARP. (Figure 1) In multivariable analysis, predictors of BCR were PSA, Gleason score, extra prostatic disease, seminal vesicle invasion and number of operations (p < 0.05). Patients harboring PSM showed higher BCR risk (23% vs. 8%, p < 0.05) CONCLUSIONS Learning curve trends in our large, single center experience shows correlation between surgical experience and oncological outcomes in MIRP. Significant reduction in PSM and BCR risk at 2 years is noted after the initial 350 cases and 100 cases of LRP and RARP, respectively. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e783 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arjun Sivaraman More articles by this author Rafael Sanchez Salas More articles by this author Dominique Prapotnich More articles by this author Fabien Olivier More articles by this author Kaixin Yu More articles by this author Christian Doudeau More articles by this author Stéphane David More articles by this author Eric Barret More articles by this author Fernando P. Secin More articles by this author Alexandre Ingels More articles by this author Francois Rozet More articles by this author Marc Galiano More articles by this author Annick Mombet More articles by this author Nathalia Cathala More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...