Outcomes Of Robot-assisted Radical Prostatectomy Research Articles

Re: Effect of Surgeon Experience and Bony Pelvic Dimensions on Surgical Performance and Patient Outcomes in Robot-Assisted Radical Prostatectomy.

Re: Effect of Surgeon Experience and Bony Pelvic Dimensions on Surgical Performance and Patient Outcomes in Robot-Assisted Radical Prostatectomy.

Surgical and Functional Outcomes of Robotic-Assisted Radical Prostatectomy in Patients with Previous Transurethral Resection of the Prostate

Purpose: The purpose of this study was to assess the surgical and functional outcomes of robotic-assisted radical prostatectomy (RARP) in patients with previous transurethral resection of the prostate (TURP). Materials and Methods: The present article studies 99 patients who underwent RARP, including 13 patients with previous TURP at a single institution, in the period from April 2016 to February 2019. Propensity score matching 1:1 was performed to identify 13 patients with no previous TURP. The matched variables were age and preoperative prostate-specific antigen level. Surgical and functional outcomes were compared between the two groups. Descriptive statistics were evaluated using the Chi-square test. t-test was performed for continuous variables. Results: Regarding preoperative characteristics, no previous TURP group had a higher clinical stage (P = 0.026). The nerve-sparing procedure was similar between the two groups. Concerning intraoperative outcomes for the group with previous TURP history, the operating room time was increased by 25 min (P = 0.140), and the estimated blood loss was increased by 50 ml (P = 0.192). As for the postoperative pathological characteristics, there was no significant difference in the positive surgical margin rate between the two groups. The continence rate in the 3rd month for the group with previous TURP history was 69.2% versus 92.3% for the group with no previous TURP history, and after the 1st year, the rates were 100% versus. 92.3%. There was no significant difference in the potence recovery rate between the two groups after 1-year follow-up. Conclusion: RARP is safe and feasible in patients with localized prostate cancer with previous TURP history. Functional outcomes after 1-year follow-up were comparable for patients with previous TURP.

Associations between Hospital Volume and Outcomes of Robot-Assisted Radical Prostatectomy.

Robot-assisted radical prostatectomy has become the predominant surgical modality to manage localized prostate cancer in the U.S. However, there are few studies focusing on the associations between hospital volume and outcomes of robot-assisted radical prostatectomy. We identified robot-assisted radical prostatectomies for clinically localized (cT1-2N0M0) prostate cancer diagnosed between 2010 and 2014 in the National Cancer Database. We categorized annual average hospital robot-assisted radical prostatectomy volume into very low, low, medium, high and very high by most closely sorting the final included patients into 5 equal-sized groups (quintiles). Outcomes included 30-day mortality, 90-day mortality, conversion (to open), prolonged length of stay (more than 2 days), 30-day (unplanned) readmission, positive surgical margin and lymph node dissection rates. A total of 114,957 patients were included in the study, and hospital volume was categorized into very low (3 to 45 cases per year), low (46 to 72), medium (73 to 113), high (114 to 218) and very high (219 or more). Overall 30-day mortality (0.12%), 90-day mortality (0.16%) and conversion rates (0.65%) were low. Multivariable logistic regressions showed that compared with the very low volume group, higher hospital volume was associated with lower odds of conversion to open surgery (OR 0.23, p <0.001 for very high), prolonged length of stay (OR 0.25, p <0.001 for very high), 30-day readmission (OR 0.53, p <0.001 for very high) and positive surgical margins (OR 0.61, p <0.001 for very high). Higher hospital volume was also associated with higher odds of lymph node dissection in the intermediate/high risk cohort (OR 3.23, p <0.001 for very high). Patients undergoing robot-assisted radical prostatectomy at higher volume hospitals are likely to have improved perioperative and superior oncologic outcomes compared to lower volume hospitals.

Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer.

To compare the oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP). We compared patients who underwent the RARP (n=778) and LRP (n=48) techniques for prostate cancer between January 2008 and July 2017 in our clinic. Patient demographics, preoperative and postoperative data, pathologic evaluation, continence, and potency rates were collected and analyzed retrospectively. The preoperative and demographic data of the patients we included in our study were similar. The mean operation time estimated blood loss, length of hospitalization, and catheterization time were significantly shorter in the RARP group. The statistical analysis was in favor of robotic prostatectomy in the terms of the mean length of hospitalization, catheterization time, and early (<30 days) and intermediate (31-90 days) complications. Positive surgical margins and biochemical recurrence rates, and recovery of continence and erectile function, were similar in both groups. RARP and LRP in organ-confined prostate cancer are safe and effective methods. Robotic prostatectomy has a shorter operative time, length of hospitalization, catheterization time, and lower early and late complication rates.

Regular vs. selective use of closed suction drains following robot-assisted radical prostatectomy: results from a regional quality improvement collaborative.

Closed suction drain (CSD) placement is common in robot-assisted radical prostatectomy (RARP). Our goal is to quantify outcomes of RARP for patients undergoing RARP by surgeons who regularly or selectively use CSDs. Patients undergoing RARP (4/2014-7/2017) were prospectively entered into the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry. Outcomes included length of stay (LOS) >2 days, >16-day catheterization, 30-day readmission, and clinically significant urine leak or ileus. Retrospective analysis of each adverse event was performed comparing groups using chi-square tests. In all, 6746 RARPs were performed by 115 MUSIC surgeons. CSDs were used in 4451 RARP (66.0%), with wide variation in surgeon CSD use (median: 94.7%, range: 0-100%, IQR: 45-100%). The cohorts of patients treated by surgeons with regular vs. selective CSD usage were similar. CSD use pattern was not associated with rates of prolonged catheterization (4.6% vs. 3.9%, p = 0.17) or readmission (4.5% vs. 4.0%, p = 0.35) and multivariable analysis confirmed these findings (each p > 0.10). Regular CSD use was associated with LOS >2 days (8.4% vs. 6.3%, p = 0.001) and multivariable analyses indicated an odds ratio (OR) of 1.42 (95% CI: 1.12-1.79; p = 0.017) and increased likelihood of clinically significant ileus (OR: 1.64; CI: 1.14-2.35; p = 0.008). Although there are specific situations in which CSDs are beneficial, e.g. anastomotic leak or observed lymphatic drainage, regular CSD use during RARP was associated with a greater likelihood of LOS >2 days and clinically significant ileus. Our data suggest that CSD should be placed selectively rather than routinely after RARP.

Clinical and oncological outcomes of robot-assisted radical prostatectomy with nerve sparing vs. non-nerve sparing for high-risk prostate cancer cases.

Robot-assisted radical prostatectomy (RARP) is one of the most widely used procedures for localized prostate cancer (PCa). In the present study, the clinical and oncological outcomes of RARP with bilateral or unilateral nerve sparing (NS) for D'Amico high-risk PCa cases were assessed. Among the 767 cases who received RARP at Fujita Health University Hospital between August 2009 and December 2016, 230 high-risk PCa cases who were observed for >6 months comprised the retrospective study cohort. Bilateral NS was performed with the bilateral neurovascular bundle in eight, unilateral in 125 and none in 97 cases. Perioperative parameters [surgery time, console time, estimated blood loss, pathological stage, positive lymph node metastases [pN (+)], and surgical margin positivity] did not exhibit significant differences between the NS and non-NS cohorts. During a median follow-up time of 25 months, the 1- and 3-year biochemical recurrence (BCR)-free survival rates in the NS/non-NS cohorts were 84.4/86.0 and 72.7/75.0%, respectively. There were no significant differences identified between the two groups at each time period. According to multivariate analysis, the resection margin was an important factor for time to BCR, regardless of the NS technique used. The numbers of pads used daily at 3 and 6 months after RARP between the NS/non-NS cohorts were 1.1/1.5 and 0.6/1.0, respectively (P=0.045 and P=0.009), suggesting that the NS technique resulted in significantly improved outcomes regarding urinary continence recovery. In selected high-risk PCa cases, the NS technique resulted in equivalent oncological outcomes and improved urinary continence compared with the non-NS RARP group.

The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study.

Improved cancer control with increasing surgical experience (the learning curve) has been demonstrated for open and laparoscopic prostatectomy. We assessed the relationship between surgical experience and oncologic outcomes of robot-assisted radical prostatectomy. We analyzed the records of 1,827 patients in whom prostate cancer was treated with robot-assisted radical prostatectomy. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. We evaluated the relationship of prior surgeon experience to the probability of positive margins and biochemical recurrence in regression models adjusting for stage, grade and prostate specific antigen. After adjusting for case mix, greater surgeon experience was associated with a lower probability of positive surgical margins (p = 0.035). The risk of positive margins decreased from 16.7% to 9.6% in patients treated by a surgeon with 10 and 250 prior procedures, respectively (risk difference 7.1%, 95% CI 1.7-12.2). In patients with nonorgan confined disease the predicted probability of positive margins was 38.4% in those treated by surgeons with 10 prior operations and 24.9% in those treated by surgeons with 250 prior operations (absolute risk reduction 13.5%, 95% CI -3.4-22.5). The relationship between surgical experience and the risk of biochemical recurrence after surgery was not significant (p = 0.8). Specific techniques used by experienced surgeons which are associated with improved margin rates need further research. The impact of experience on cancer control after robotic prostatectomy differed from that in the prior literature on open and laparoscopic radical prostatectomy, and should be investigated in larger multi-institutional studies.

Robot-assisted radical prostatectomy versus volumetric modulated arc therapy: Comparison of front-line therapies for localized prostate cancer

BackgroundAlthough radical prostatectomy and external beam radiotherapy are recognized as comparable treatment options for localized prostate cancer, robot-assisted radical prostatectomy (RARP) and volumetric modulated arc therapy (VMAT) as the leading respective techniques have yet to be compared. MethodsWe retrospectively analyzed 860 patients with cT1-4N0M0 prostate cancer who underwent RARP (n = 500) or VMAT (n = 360) between 2011 and 2016. Biochemical recurrence-free survival (bRFS; two consecutive prostate-specific antigen measurements ≥0.2 ng/ml for RARP and Phoenix definition for VMAT) and radiological recurrence-free survival (rRFS; radiologically diagnosed distant metastasis or local recurrence) were compared between the two modalities. Cox proportional hazards model was used for multivariate analysis. ResultsThe median follow-up durations were 30 and 47.5 months, and median ages were 67 and 71 years (both P < 0.0001) in the RARP and VMAT groups, respectively. VMAT patients had significantly better bRFS than RARP patients, though their definitions of biochemical recurrence differed. If a unified definition of biochemical recurrence (two consecutive prostate-specific antigen measurements ≥0.2 ng/ml) was applied, RARP patients had significantly better bRFS than VMAT patients. Regarding rRFS, RARP patients had significantly better outcomes than VMAT patients, however, multivariate analysis together with D’Amico’s risk classification, age-adjusted Charlson’s comorbidity index, and concomitant androgen-deprivation therapy, demonstrated no significant difference between RARP and VMAT. ConclusionsThe rRFS outcomes of RARP and VMAT after a medium-term follow-up period were similar, despite their different patient backgrounds. Further studies with a longer follow-up period are needed to compare these techniques in terms of cancer-specific and overall survivals.

Robot-assisted radical prostatectomy. Functional result. Part I. (in Russian only)

Robot-assisted operations as widely used in urology, gynecology, general and cardiovascular surgery are considered by many experts as a new 'gold standard' of surgical treatment of various diseases in developed countries. Robot-assisted radical prostatectomy for prostate cancer is the most common robotic procedure. Better functional outcomes of robot-assisted radical prostatectomy are due to another (new) understanding of pelvic surgical anatomy, new approach implying dissection and preservation of external urethral sphincter and neurovascular structures. Prostate neuroanatomy, various approaches to preserve neurovascular structures and own experience of nerve-sparing robot-assisted radical prostatectomy with functional results are reviewed in the article.

Oncologic outcomes in prostate cancer patients treated with robot-assisted radical prostatectomy: results from a single institution series with more than 10 years follow up.

Robot-assisted radical prostatectomy (RARP) has gained increasing diffusion as standard of care in the surgical treatment of prostate cancer (PCa) patients, even in the absence of robust long-term oncologic comparative data. This article is a report of oncologic outcomes of RARP at more than 10 years follow-up. We retrospectively evaluated 173 consecutive PCa patients underwent RARP between 2002 and 2005 at a single European center with complete clinic and pathologic data and potential follow-up of at least 10 years. Kaplan-Meier analyses assessed biochemical recurrence free survival (BCR-FS), clinical recurrence free survival (CR-FS), cancer specific mortality free survival (CSM-FS), other causes mortality free survival (OCM-FS) in the overall population and CR-FS after stratification according to pathologic stage and Gleason score. Multi-variable Cox regression analyses were performed to assess the predictors of BCR and CR. Median follow-up (Interquatile Range [IQR]) was 133 (123-145) months. The BCR-FS, CR-FS, CSM-FS and OCM-FS rates at median follow-up were 73.4%, 81.1%, 95.7%, and 68.6%, respectively. Patients staged as pT3b-T4 and men with Gleason score 8-10 experienced significantly lower CR-FS rates as compared to those with less aggressive pathologic features (all P≤0.001). At multivariable analysis, pathologic Gleason score 8-10 (Hazard Ratio [HR]: 2.85), pathologic stage pT3b-pT4 (HR: 2.76) and adjuvant therapy (HR: 2.09 for radiotherapy [RT] and HR: 13.66 for androgen deprivation therapy [ADT]) were independent predictors of BCR (all p≤0.02). While, pathologic Gleason score 8-10 (HR: 4.05) and pathologic stage pT3b-pT4 (HR: 6.78) were found to be independently related to higher risk of CR (all P≤0.03). Retrospective data and limited number of patients included could have affected our analyses. In experienced centers, RARP allows optimal oncologic outcomes at long term follow-up. Adverse pathologic characteristics are independent predictors of BCR and CR.

P032 - Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors

P032 - Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors

Clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy.

The present study investigated clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy (RARP). The study included 625 Japanese cases treated with RARP between 2009 and 2017. The association between clinical factors (age, overweight status, prostate volume, clinical T-stage, nerve sparing, lympho-node dissection, and the number of experienced cases) and perioperative outcomes (operation time, estimated blood loss, catheterization duration, and perioperative complication) were analyzed. Results revealed that overweight status, prostate volume, lymph-node dissection, and the number of experienced cases were associated with operation time. For estimated blood loss, the identified risk factors were overweight status, prostate volume, nerve sparing, lymph-node dissection, and the number of experienced cases. Lymph-node dissection and the number of experienced cases were also associated with catheterization duration. Additionally, only lymph-node dissection was associated with increased perioperative complication. Taken together, the present study identified several clinical factors affecting perioperative outcomes in RARP. This information may help surgeons to estimate perioperative outcomes as well as to inform patients.

PE37 - The oncologic outcome of robot-assisted radical prostatectomy with pelvic lymph node dissection in the patients with cN0 high-risk prostate cancer

PE37 - The oncologic outcome of robot-assisted radical prostatectomy with pelvic lymph node dissection in the patients with cN0 high-risk prostate cancer

Safety and Clinical Outcomes of Robot-Assisted Radical Prostatectomy in Kidney Transplant Patients: A Systematic Review.

To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature. A literature search was performed using PubMed, Embase, and Web of Science through "robot" AND "prostatectomy" AND "transplant." Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review. We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%. RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.

Use of cumulative summation (CUSUM) as a tool for early feedback and monitoring in robot-assisted radical prostatectomy outcomes and performance.

Today's surgical practice has evolved, with increasing emphasis on quality assurance. Many forms of quality-control monitoring have been suggested, but they are often impractical or difficult to implement. Cumulative summation (CUSUM) is a simple method to provide visual feedback before significant quality issues arise. We present our initial use and practical application of CUSUM in a surgical practice. A retrospective analysis was applied to a prospectively collected database of 577 sequential patients who have undergone robot-assisted radical prostatectomy from a single surgeon over a 10-year period. Outcome measures were analyzed with CUSUM, which included a composite complication score, continence rates, length of hospital stay, biochemical recurrence, and need for adjuvant radiation. If any outcomes were out of control, they would cross the CUSUM failure line. CUSUM chart-plotting for incontinence demonstrated an initial upward slope followed by trending to a new safety limit. Additionally, outcomes in complications and biochemical recurrence did not reach the established safety boundaries. Length of stay and radiation outcomes did initially cross the safety line, but were improved over time. The use of CUSUM in clinical practice can fulfill the need for quality assurance. CUSUM plotting in our practice reflected the initial learning curve, followed by ongoing maintenance and improvement in performance. These changes were consistent with the implementation of changes in surgical techniques. Although this tool was used retrospectively, this strengthens our argument to implement the tool prospectively and assess real-time refinement of surgeon skill. We have demonstrated that CUSUM can be appropriately used to assure quality control in a surgical practice.

Functional outcomes of robot-assisted radical prostatectomy in patients eligible for active surveillance.

To assess the outcome of low risk prostate cancer (PCa) patients who were candidates for active surveillance (AS) but had undergone robot-assisted radical prostatectomy (RARP). We reviewed our prospectively collected database of patients operated by RARP between 2006 and 2014. Low D'Amico risk patients were selected. Oncological outcomes were reported based on pathology results and biochemical failure. Functional outcomes on continence and potency were reported at 12 and 24months. Continence was assessed by the number of pads per day. With respect to potency, it was assessed using the Sexual Health Inventory for Men (SHIM) and Erectile Hardness Scale (EHS). Out of 812 patients, 237 (29.2%) patients were D'Amico low risk and were eligible for analysis. 44 men fit Epstein's criteria. 134 (56.5%) men had pathological upgrading. Age and clinical stage were predictors of upgrading on multivariate analysis. 220 (92.8%) patients had available follow-up for biochemical recurrence, potency, and continence for 2years. The mean and median follow-up was 34.8 and 31.4months, respectively. Only 5 (2.3%) men developed BCR, all of whom had pathological upgrading. Extra capsular extension and positive surgical margins were observed in 14.8 and 19.1%, respectively. 0 pad was achieved in 86.7 and 88.9% at 1 and 2years, respectively. Proportion of patients with SHIM > 21 at 1 and 2years was 24.8 and 30.6%, respectively. Moreover, patients having erections adequate for intercourse (EHS ≥ 3) were seen in 69.6 and 83.1% at 1 and 2years, respectively. Functional outcomes of patients fitting Epstein's criteria (n = 44) and patients with no upgrading on final pathology (n = 103) were not significantly different compared to the overall low risk study group. This retrospective study showed that RARP is not without harm even in patients with low risk disease. On the other hand, considerable rate of upgrading was noted.

PD38-11 USING VIDEO ANALYSIS TO UNDERSTAND THE TECHNICAL VARIATION OF ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) IN A STATEWIDE SURGICAL COLLABORATIVE

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2018PD38-11 USING VIDEO ANALYSIS TO UNDERSTAND THE TECHNICAL VARIATION OF ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP) IN A STATEWIDE SURGICAL COLLABORATIVE Parin Patel, Tae Kim, Zack Prebay, Jaya Telang, Susan Linsell, Eduardo Kleer, David Miller, James O. Peabody, Khurshid R. Ghani, and William K. Johnston III Parin PatelParin Patel More articles by this author , Tae KimTae Kim More articles by this author , Zack PrebayZack Prebay More articles by this author , Jaya TelangJaya Telang More articles by this author , Susan LinsellSusan Linsell More articles by this author , Eduardo KleerEduardo Kleer More articles by this author , David MillerDavid Miller More articles by this author , James O. PeabodyJames O. Peabody More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and William K. Johnston IIIWilliam K. Johnston III More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Video assessment is an emerging tool for understanding variation in surgical technique. Despite its widespread adoption, patient outcomes for RARP may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a statewide collaborative. METHODS The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative consisting of 260 urologists from 44 diverse community and academic practices, with the aim of improving prostate cancer care. Representative complete videos of nerve-sparing RARP were voluntarily submitted to the MUSIC coordinating center. The duration and variations in the tasks performed during each part were captured. RESULTS The anterior approach was used by 65% of surgeons (vs posterior) for the seminal vesicle (SV) dissection. Captured video analysis data identified variation in time to complete different steps (Figure 1): bladder takedown (2-24 mins), endopelvic fascia dissection (4-11 mins), dorsal venous complex (DVC) control (2-10 mins), bladder neck dissection (7-30 mins), SV dissection (9-32 mins), nerve-sparing/pedicle control (8-33 mins), apical dissection (4-17 mins), and anastomosis (17-44 mins). Seven different permutations involving suture, staples and electrocautery for dividing/controlling the DVC were used. Management of the pedicle/nerve-sparing was performed using hem-o-lok clips (15), Enseal tissue sealer (4), and titanium clips (1). Prior to anastomosis, only 5/20 undertook a posterior reconstruction. A non-barbed (vs barbed) running suture (12/20) was the predominant anastomosis method and 6/20 placed a urethral suspension stitch. At the end, 50% of surgeons performed a bladder leak test with 11/20 surgeons placing drains regardless of the result. Two surgeons utilized SP tubes for bladder drainage. CONCLUSIONS RARP technique is not uniform. Video analysis identified variation in (1) time to complete each step (2) methods for DVC control, (3) nerve-sparing technique, and (4) performance of the urethrovesical anastomosis. Future efforts linking differences in technique with clinical outcomes can provide objective evidence to support best practices. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e740-e741 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Parin Patel More articles by this author Tae Kim More articles by this author Zack Prebay More articles by this author Jaya Telang More articles by this author Susan Linsell More articles by this author Eduardo Kleer More articles by this author David Miller More articles by this author James O. Peabody More articles by this author Khurshid R. Ghani More articles by this author William K. Johnston III More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Review of optimal techniques for robotic-assisted radical prostatectomy.

Robotic-assisted radical prostatectomy has been rapidly adopted and is now the standard of care in the surgical management of prostate cancer. Since the initial description in 2001, the technique has evolved to optimize oncological functional outcomes. Herein, we review key techniques for the robotic-assisted radical prostatectomy. With the current influx of new technology such as focal therapy, stereotactic body radiation therapy and prostate-sparing treatments, there is greater emphasis on maximizing outcomes of robotic-assisted radical prostatectomy. The evidence-based techniques of optimizing oncological outcomes including the lymph node dissection and improving cancer control through minimizing positive surgical margins are reviewed. Improvements in functional recovery has also been seen with technical modifications such as nerve sparing, preservation of the urethral support structures and the bladder neck and the urethra-vesical reconstruction. Robotic prostatectomy has demonstrated adequate long-term oncologic success and satisfactory functional recovery. As technology and techniques in robotic-assisted surgery evolve, surgeons will continue to optimize techniques to maximize functional outcome recovery and cancer control. Further studies are actively being conducted to provide level one evidence in multiple aspects of the robotic-assisted radical prostatectomy.

529 - Outcomes of robot-assisted radical prostatectomy before and after renal transplant

529 - Outcomes of robot-assisted radical prostatectomy before and after renal transplant

Outcomes of robotic-assisted radical prostatectomy for patients in two extreme age-groups (< 50 years vs > 65 years).

Background and aimsTo assess the outcomes of robotic radical prostatectomy in two different age subgroups of pre-operatively potent patients: younger than 50 years and older than 65 years.MethodsWe included in the present study a number of 202 patients with prostate cancer divided into two groups: 99 patients older than 65 years (group 1) and 103 patients younger than 50 years (group 2).ResultsMore than half of the younger patients were low-risk vs 57% of the older patients who were high-risk. Overall positive surgical margins rate was 21.2% in group 1 vs 12.1% in group 2. The early biochemical recurrence at 6 months after radical prostatectomy was 4% in group 1 vs 11.6% in group 2. The continence rate at 6 months was similar between the two groups and was not correlated with the patients’ age (p=0.72), nerve-sparing (p=0.3 for group 1, p=0.92 for group 2) or pathological staging (overall p=0.81, p=0.89 in group 1 and p=0.63 in group 2). We observed a significantly higher rate of potency for patients in group 2 (91.5% vs 47.2%, p<0.0001). The most important factor associated with the regain of potency at 6 months after the procedure was the age of the patient (p<0.0001), independently of the type of nerve-sparing performed.ConclusionsAge seems to be the most important predictor of the regain of potency after robotic radical prostatectomy. Patients should be counseled accordingly in order to have realistic expectations about the functional results after robotic-assisted surgery.