PYJ15: A health and economic analysis of robotic prostatectomy in the Australian public health system

Abstract

of 233 consecutive patients with intermediateor high-risk clinically localised prostate cancer underwent RARP and ePLND by a single experienced open and laparoscopic surgeon at our institution. Clinical and pathological datawere prospectively collected. Complications were classified according to the Modified Clavien System. Biochemical recurrence was defined as two consecutive PSA ≥0.2 ng/ml. Urinary continence was defined as no leakage at all. Potency was defined as erectile function allowing sexual intercourse with/without phosphodiesterase-5 inhibitors. Only patients who were potent preoperatively and did undergo nerve-sparing RARPwere evaluated concerning potency recovery. Patients with and without prior abdominal surgery were compared by performing a logistic regression using Wilcoxon rank sum test,Wald Chi squared test and Fisher’s exact test. Statistical significance is defined as p≤0.05. Results: Among 233 patients, 49 (21%) had undergone prior abdominal surgery (Group 1) and 184 (79%) had not undergone prior abdominal surgery (Group 2). The most frequent operations were inguinal hernia (44%) and appendectomy (30%). The two groups were comparable for all preoperative variables. The minimum follow-up was 1 year. There were no statistically significant differences between Group 1 and Group 2 in median operative time (276 vs 272 min), number of nodes removed (16 vs 17), rates of nerve-sparing procedures (75% vs 67%), median length of stay (8 vs 7.7 d), catheterfree rates on POD 5 (98% vs 96%) and pathological tumour stadium. The two groups had similar complication rates (44% vs 41%) and no access-related complications were observed in Group 1. For Group 1 and Group 2 biochemical recurrence-free survival rates were 84% (41/49 pts) and 89% (164/184 pts) (p=0.073). Continence rates were 100% (49/49 pts) and 93% (171/184 pts) (p=0.092), whereas a recovery of erectile function was achieved in 65% (18/28 pts) and 62% (62/100 pts) (p=0.672), respectively. Conclusions: The transperitoneal robot-assisted radical prostatectomy with extended pelvic lymph node dissection is feasible and safe in the setting of prior abdominal surgery. The procedure can be performed without an increase in complications and no detrimental effect on functional outcomes is to be expected. However, long-term follow-up is required to draw definitive oncological conclusions.