50 Vs 50
A Comparison of the Oncologic
Outcomes of Retropubic Prostatectomy
and Robotic Prostatectomy
Chris Ogden
Tim Christmas
Jordan Durrant
Khalid A E Shendi
Rene Woderich
Background




The Robotic Prostatectomy Program at The Royal
Marsden began in late 2006 , led by Chris Ogden.
Previously, Retropubic Prostatectomy was
performed by Tim Christmas.
During this Transition period, a comparison of the
two methods was made.
Chris Ogden is now proctoring other Institutions
making this transition.
Introduction

Beginning on 1st January 2007, the details of 50
consecutive Robotic Assisted Laparoscopic
Prostatectomy cases were entered into a
database and compared with the last 50
consecutive Radical Retropubic Prostatectomy
cases.
Methods
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Patient Data:

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
Age
Pre-Operative PSA, Staging,
Gleason Score
Pre-Operative Haemoglobin
Pre-Operative MRI Staging
Methods

Measured Outcomes
were:
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Anaesthetic Time
Post-Operative
Haemoglobin
Number of Nights in
Hospital
Post-Operative
Histopathology
Positive Margin Rate
Methods

All patients had 12 months
follow-up with 3 monthly PSA
checks.
Surgical Technique

Radical Retropubic Prostatectomy


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Midline Vertical Skin Incision
Bladder Neck and Nerve Preserving
Yates Drain
Planned In-Patient Stay of 7-10 days, TWOC
prior to discharge
Surgical Technique

Robot Assisted
Laparoscopic
Prostatectomy




6 ports
Robinson’s drain for 12-24
hours
Planned In-Patient Stay of
1-2 days
TWOC as Out-Patient at 10
days
The Patient Groups
50

consecutive patients in each group. Non-randomised, no matching.
Median Age


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: 62
: 61
Retropubic
Robotic
: 8.2
: 7.1
Retropubic
Robotic
: 6%
: 8%
Median PSA



Retropubic
Robotic
Percentage with MRI T3
Staging Pre-Op


The Surgery
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Median Time Under
Anaesthesia
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
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: 95 mins
: 270 mins
Percentage Patients with Hb
Drop > 4g/dL

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
Retropubic
Robotic
Retropubic
Robotic
: 40%
: 12%
Median Number of Post-Op
Nights in Hospital


Retropubic
Robotic
: 9 nights
: 2 nights
Mean  SEM
10
5
p < 0.0001
ro
b
ot
ic
0
op
en
Mean of Hospital Stay (nights)
15
Operative Group
Hospital Stay (nights)

Reduction in Hospital Stay significant, unpaired T test shows p=<0.0001
Hb Drop (gm/100 mL)
5
Mean  SEM
4
3
2
1
p < 0.0002
ot
ic
ro
b
op
en
0
Operative Group
Hb Drop (gm/100mL)

Difference in blood loss significant, unpaired T test shows p=0.0002
Oncologic Outcomes
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Stage > pT3 on Final
Post-Op Histology
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Retropubic
Robotic
: 32%
: 18%
Positive Margin Rate
in pT2 Tumours
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Retropubic
Robotic
: 24%
: 14%
12 Month Follow-Up
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Biochemical
Recurrence in First 12
months


Retropubic
Robotic
: 22%
: 4%
Conclusions


The two groups are comparable, however, the
lower PSA recurrence rate in Robotic Group is in
part related to lower incidence of T3 tumours.
There are early Oncologic
advantages in making the
transition to Robotic
Prostatectomy.
Conclusions

The Robotic patients have a shorter hospital stay
and less morbidity from blood loss.
The Future


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Our database now has over 200 cases, we
look forward to presenting this data a
WRS.
The data shows a consistent Positive
Margin Rate of 14.7%.
27% of patients are discharged within 24
hours of surgery.
The Future
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
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PSA recurrence within 12 months confined
to 7.6% of patients.
85% of patients pad-free at 12 months.
Median console time of 145 minutes.
The End
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Any questions?