Robotic radical prostatectomy: perioperative, pathologic and functional outcomes
in a low volume center
Gianluca D'Elia, Paolo Emiliozzi, Gianfranco Ortolani, Antonio Iannello, Ospedale
San Giovanni, Roma, Italy
Reports of high-volume centers with robotic radical prostatectomy are readily
available. However, evaluation of functional and oncological outcome as well as
complications from low-caseload centers is lacking. We report on our experience in
a community setting low-volume center (less than 85 procedures / year).
A total of 282 patients underwent robotic radical prostatectomy during a 42-month
period. Two surgeons performed all the procedures. The senior surgeon proctored the
junior surgeon after the first 50 cases utilizing a step-by-step approach. Perioperative
data and functional and pathological results were prospectively collected.
Perioperative outcome measures included: operative time, estimated blood loss,
transfusion rate, complication rate according to modified Clavien system, median
hospital stay, mean catheterization time. Pathologic outcome measures encompassed
positive surgical margin rate and biochemical recurrence free survival (PSA < 0.2).
Perioperative and pathologic outcomes were also analyzed using prostate weight as a
continuous variable by multivariate regression. Return of continence was evaluated at
1, 3, 6 and 12 months (continent 0 pads; incontinent 1 or more pads). Return of
potency was evaluated at 1, 3, 6 and 12 months with IIEF-5 scores in 178 patients
who underwent a nerve-sparing procedure (mean age 61 years; range 47 - 67).
Mean age was 64.2 years. Mean body mass index (BMI) was 26.6. Median
preoperative PSA level was 7.6 ng/ml. Mean operative time was 158 minutes. Mean
estimated blood loss was 180 cc. Blood transfusion was needed in 3 patients. Median
hospital stay was 4 days, mean catheterization time was 8.4 days. According to the
modified Clavien system, grade III complication rate was 2.6 %, whereas minor
complication rate was 22%. Positive surgical margin rate was 9.8 % for pT2 disease
and 29 % for pT3 disease. Mean prostate weight was 53 g. No correlation between
prostate weight, perioperative outcomes and positive margins was found at the
multivariate regression analysis (p > 0,5). Overall biochemical recurrence free
survival is 95% at mean follow up of 10.9 months. Complete continence (pad free) at
1, 3, 6, and 12 months was 57%, 88%, 94% and 98%, respectively. At 1, 3, 6 and 12
months return of potency (IIEF-5 > 21) with or without the use of oral medications
was achieved in 6%, 22%, 51% and 68%, respectively.
Robotic radical prostatectomy has a low perioperative complication rate and
acceptable pathologic and functional outcomes despite a limited caseload. Two
surgeons accomplished their learning curve within 100 cases without posing
outcomes at risk. Perioperative and pathologic outcomes seem to be unrelated to
prostate weight.
Finanziamento
No
Conflitto d'Interesse
No
Argomento
Oncologia Prostata