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 Patient Data: Age Pre-Operative PSA, Staging, Gleason Score Pre-Operative Haemoglobin Pre-Operative MRI Staging Methods Measured Outcomes were: 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 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 : 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 Median Time Under Anaesthesia : 95 mins : 270 mins Percentage Patients with Hb Drop > 4g/dL 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 Stage > pT3 on Final Post-Op Histology Retropubic Robotic : 32% : 18% Positive Margin Rate in pT2 Tumours Retropubic Robotic : 24% : 14% 12 Month Follow-Up 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 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 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 Any questions?