Radical prostatectomy for prostate cancer: Hong Kong status in the era of Surgical Outcomes Monitoring and Improvement Programme

Abstract

AbstractAimThe aim of the present study was to show the status of radical prostatectomy (RP) for prostate cancer since the introduction of the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) among hospitals from six clusters under the Hospital Authority.Patients and MethodsAll RPs including robot‐assisted laparoscopic RP (RALRP), traditional laparoscopic RP (LRP) and open RP (ORP) performed between July 2009 and June 2017 were reviewed through electronic patient records under the SOMIP. The pre‐operative cancer characteristics, perioperative parameters, pathology, functional outcomes and early oncological outcomes were studied.ResultsA total of 1998 men were included in the analysis including 1446 RALRP, 500 LRP and 52 ORP cases. The overall mean procedure time was 295, 258 and 239 minutes, respectively. About 80.4% of RP cases had blood loss of more than 100 ml with a mean blood loss of 671 ml and transfusion rate of 7.4%. The overall 30‐day morbidity rate was 13.2%, including anastomotic leakage rate of 3.9% and unplanned readmission rate of 2.5%. Only 1 (0.2%) procedure‐related mortality was reported in the LRP group. The mean pre‐operative serum prostate‐specific antigen level was 10.9 ng/mL and 93.6% achieved less than 0.1 ng/mL after the operation. RALRP had a significantly less estimated blood loss (581 ml vs. 759 ml; P < .0001), less transfusion rate (5% vs. 10.8%; P < .0001) and less morbidity rate (10.4% vs. 19.4%; P < .0001) than LRP. RALRP also had a shorter length of post‐operative stay (5.5 days vs. 8.3 days; P < .0001) and better early continence rate at 3 months (39.5% vs. 27.6%; P = .0001) as well as 6 months (58.4% vs. 51.1%; P = .007) than LRP. Positive surgical margins were noted to be lower in the RALRP group (27.2% vs. 38.4%).ConclusionRALRP seems to be the standard approach for prostate cancer in Hong Kong. The procedure showed greater minimally invasive benefit, better early functional outcome and early oncological outcome of better surgical margin positive rate.