Robot assisted radical prostatectomy and pelvic lymph node dissection in a center
with small case load: functional results at follow-up of 5 years.
G.B Di Pierro G, G. La Croce , C. Germann C, A. Rhuele, M. Ferrari, P. Stucky, H.
Danuser , A. Mattei Luzerner kantonsspital, Lucerne, Switzerland
INTRODUCTION With a case load of ca. 60 robot assisted radical prostatectomy (RARP) per year the
Luzerner Kantonsspital, Lucerne (SWITZERLAND) can be defined a center with a small case load. A
fortiori we are willing to document functional results of RARP. Especially since results of high volume
reference centers have generously been published there still a lack of results concerning outcomes
from low-caseload centers.
METHODS The Robotic Surgery program at the Lucerne Kantonsspital was started 2008. Between
August 2008 and September 2013 we prospectively collected data on 297 RARP performed by a
single surgeon. Postoperatively patients were controlled at 3 and 12 months and later yearly.
Functional end points were urinary continence and erectile function data investigated respectively with
3 ICIQ and IIEF-EF questionnaires.
RESULTS Median follow up was 31.5 Months (range 1.2-62.3 Months). Median patients age at
surgery was 64.5 years (range 46-76.2 years), BMI median was 26.7 (range 18.8-42.9). PSA median
before surgery was 8.6 ng/mL (range 1.2–50 ng/mL). Median prostatic volume measured by trans
rectal ultrasound was 40 cc (range 25-120 cc). Median number of lymph nodes removed was 16
(range 4-43) and 88.9% of patients were free from nodal metastasis. Three Months after the operation
PSA was <0,2 ng/mL in 95% of patients, median 0.01 ng/mL (range 0-17.1 ng/mL). Three months
after the operation continence rates according to the ICIQ questionnaire were 85% and only 12% still
used a safety PAD. Global continence rates were 98% after 1 year. The median continence recovery
time was 5 Months (range 3-13 Months). According to the IIEF-EF questionnaire 44% (IIEF-EF score
≤10), 15% (IIEF-EF score ≤16) and 16% (IIEF-EF score ≤25) of patients were affected respectively by
severe, moderate and light erectile dysfunction (ED) before the operation. Only the 25% of patients
were fully potent (IIEF-EF score ≥ 26). Recovery of erectile function was 32% after 3 months and 72
%after 1 year (considering potent patients with IIEF-EF score ≥ 17) with a medium recovery time of 8
months (considering also patients under pharmacological treatment). There were no conversions to
open surgery and no major intraoperative complications.
DISCUSSION If performed by experienced surgical teams RARP offers good results in terms of
continence, erection recovery and oncological results, even in limited caseload centres.
CONCLUSION Despite the relatively low case load our 5 year oncological and functional RARP
results are comparable with those of high volume centres and data reported in the literature.