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World Journal of Urology

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01-02-2014 | Original Article

Comparison of oncological outcomes between retropubic radical prostatectomy and robot-assisted radical prostatectomy: an analysis stratified by surgical experience

Authors: Jinsung Park, Dae-Seon Yoo, Cheryn Song, Sahyun Park, Sejun Park, Seong Cheol Kim, Yongmee Cho, Hanjong Ahn

Published in: World Journal of Urology | Issue 1/2014

Abstract

Objectives

To compare oncological outcomes of a consecutive retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) series performed by a single surgeon who had performed >750 prior RRPs and was starting to perform RARPs.

Materials and methods

Prospectively collected longitudinal data of 277 RRP and 730 RARP cases over a 5-year period were retrospectively analyzed. The RARP series were divided into 3 subgroups (1st, <250 cases; 2nd, 250–500; and 3rd, >500) according to the surgical period. The positive surgical margin (PSM) and biochemical recurrence-free survival (BCRFS) rates were compared at each pathological stage.

Results

The pT2 PSM rates showed no significant difference between the RRP (7.8 %) and RARP series (1st, 9.5 %; 2nd, 14.1 %; and 3rd, 9.8 %) throughout the study period (P = 0.689, 0.079, and 0.688, respectively). Although the pT3 PSM rates of the 1st (50.6 %) and 2nd RARP series (50.0 %) were higher than that of the RRP series (36.0 %; P = 0.044 and P = 0.069, respectively), the 3rd RARP series had a comparable pT3 PSM rate (32.4 %, P = 0.641). The 3-year BCRFS rates of the RRP and RARP series were similar at each pathological stage (pT2, 92.1 vs. 96.8 %, P = 0.517; pT3, 60.0 vs. 67.3 %, P = 0.265, respectively).

Conclusions

The pT2 PSM and short-term BCRFS rates were similar between RRP and RARP, and RARP showed comparable pT3 PSM rate with RRP after >500 cases of surgical experience. Our data suggest that an experienced robotic surgeon at a high-volume center may achieve comparable oncological outcomes with open prostatectomy even in locally advanced disease.

Zincke H, Bergstralh EJ, Blute ML, Myers RP, Barrett DM, Lieber MM, Martin SK, Oesterling JE (1994) Radical prostatectomy for clinically localized prostate cancer: long-term results of 1,143 patients from a single institution. J Clin Oncol 12(11):2254–2263PubMed

Kim SC, Song C, Kim W, Kang T, Park J, Jeong IG, Lee S, Cho YM, Ahn H (2011) Factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic. Eur Urol 60(3):413–419. doi:10.1016/j.eururo.2011.05.011 PubMedCrossRef

Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O (2009) Robotic versus open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int 104(7):991–995. doi:10.1111/j.1464-410X.2009.08532.x PubMedCrossRef

Barry MJ, Gallagher PM, Skinner JS, Fowler FJ Jr (2012) Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. J Clin Oncol 30(5):513–518. doi:10.1200/JCO.2011.36.8621 PubMedCrossRef

Menon M, Bhandari M, Gupta N, Lane Z, Peabody JO, Rogers CG, Sammon J, Siddiqui SA, Diaz M (2010) Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1,384 patients with a median 5-year follow-up. Eur Urol 58(6):838–846. doi:10.1016/j.eururo.2010.09.010 PubMedCrossRef

Liss MA, Lusch A, Morales B, Beheshti N, Skarecky D, Narula N, Osann K, Ahlering TE (2012) Robot-assisted radical prostatectomy: 5-year oncological and biochemical outcomes. J Urol 188(6):2205–2210. doi:10.1016/j.juro.2012.08.009 PubMedCrossRef

Barocas DA, Salem S, Kordan Y, Herrell SD, Chang SS, Clark PE, Davis R, Baumgartner R, Phillips S, Cookson MS, Smith JA Jr (2010) Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival. J Urol 183(3):990–996. doi:10.1016/j.juro.2009.11.017 PubMedCrossRef

D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974PubMedCrossRef

Rosen MA, Goldstone L, Lapin S, Wheeler T, Scardino PT (1992) Frequency and location of extracapsular extension and positive surgical margins in radical prostatectomy specimens. J Urol 148(2 Pt 1):331–337PubMed

10.

Patel VR, Coelho RF, Rocco B, Orvieto M, Sivaraman A, Palmer KJ, Kameh D, Santoro L, Coughlin GD, Liss M, Jeong W, Malcolm J, Stern JM, Sharma S, Zorn KC, Shikanov S, Shalhav AL, Zagaja GP, Ahlering TE, Rha KH, Albala DM, Fabrizio MD, Lee DI, Chauhan S (2011) Positive surgical margins after robotic assisted radical prostatectomy: a multi-institutional study. J Urol 186(2):511–516. doi:10.1016/j.juro.2011.03.112 PubMedCrossRef

11.

Williams AK, Chalasani V, Martinez CH, Osbourne E, Stitt L, Izawa JI, Pautler SE (2011) Cumulative summation graphs are a useful tool for monitoring positive surgical margin rates in robot-assisted radical prostatectomy. BJU Int 107(10):1648–1652. doi:10.1111/j.1464-410X.2010.09634.x PubMedCrossRef

12.

Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P (2012) Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 62(1):1–15. doi:10.1016/j.eururo.2012.02.029 PubMedCrossRef

13.

Doumerc N, Yuen C, Savdie R, Rahman MB, Rasiah KK, Pe Benito R, Delprado W, Matthews J, Haynes AM, Stricker PD (2010) Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years. BJU Int 106(3):378–384. doi:10.1111/j.1464-410X.2009.09158.x PubMedCrossRef

14.

Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Zagaja GP, Shalhav AL (2007) Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. European urology 51 (3):755-762; discussion 763. doi:10.1016/j.eururo.2006.10.019

15.

Ficarra V, Novara G, Secco S, D’Elia C, Boscolo-Berto R, Gardiman M, Cavalleri S, Artibani W (2009) Predictors of positive surgical margins after laparoscopic robot assisted radical prostatectomy. J Urol 182(6):2682–2688. doi:10.1016/j.juro.2009.08.037 PubMedCrossRef

16.

Herrell SD, Smith JA Jr (2005) Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology 66(5 Suppl):105–107. doi:10.1016/j.urology.2005.06.084 PubMedCrossRef

17.

Zorn KC, Wille MA, Thong AE, Katz MH, Shikanov SA, Razmaria A, Gofrit ON, Zagaja GP, Shalhav AL (2009) Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies. Can J Urol 16(4):4742–4749; discussion 4749

18.

Samadi DB, Muntner P, Nabizada-Pace F, Brajtbord JS, Carlucci J, Lavery HJ (2010) Improvements in robot-assisted prostatectomy: the effect of surgeon experience and technical changes on oncologic and functional outcomes. J Endourol 24(7):1105–1110. doi:10.1089/end.2010.0136 PubMedCrossRef

19.

Sooriakumaran P, John M, Wiklund P, Lee D, Nilsson A, Tewari AK (2011) Learning curve for robotic assisted laparoscopic prostatectomy: a multi-institutional study of 3794 patients. Minerva Urol Nefrol 63(3):191–198PubMed

20.

Di Pierro GB, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A (2011) A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 59(1):1–6. doi:10.1016/j.eururo.2010.10.026 PubMedCrossRef

21.

Philippou P, Waine E, Rowe E (2012) Robot-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon. J Endourol 26(8):1002–1008. doi:10.1089/end.2011.0569 PubMedCrossRef

22.

Masterson TA, Cheng L, Boris RS, Koch MO (2012) Open versus robotic-assisted radical prostatectomy: A single surgeon and pathologist comparison of pathologic and oncologic outcomes. Urol Oncol. doi:10.1016/j.urolonc.2011.12.002 PubMed

23.

Magheli A, Gonzalgo ML, Su LM, Guzzo TJ, Netto G, Humphreys EB, Han M, Partin AW, Pavlovich CP (2011) Impact of surgical technique (open vs. laparoscopic vs. robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int 107(12):1956–1962. doi:10.1111/j.1464-410X.2010.09795.x PubMedCentralPubMedCrossRef

24.

Mitchell CR, Boorjian SA, Umbreit EC, Rangel LJ, Carlson RE, Karnes RJ (2012) 20-Year survival after radical prostatectomy as initial treatment for cT3 prostate cancer. BJU Int 110(11):1709–1713. doi:10.1111/j.1464-410X.2012.11372.x PubMedCrossRef

25.

Xylinas E, Drouin SJ, Comperat E, Vaessen C, Renard-Penna R, Misrai V, Bitker MO, Chartier-Kastler E, Richard F, Cussenot O, Roupret M (2009) Oncological control after radical prostatectomy in men with clinical T3 prostate cancer: a single-centre experience. BJU Int 103 (9):1173-1178; discussion 1178. doi:10.1111/j.1464-410X.2008.08208.x

26.

Joniau S, Hsu CY, Gontero P, Spahn M, Van Poppel H (2012) Radical prostatectomy in very high-risk localized prostate cancer: long-term outcomes and outcome predictors. Scand J Urol Nephrol 46(3):164–171. doi:10.3109/00365599.2011.637956 PubMedCrossRef

27.

Engel J, Bastian PJ, Baur H, Beer V, Chaussy C, Gschwend JE, Oberneder R, Rothenberger KH, Stief CG, Holzel D (2010) Survival benefit of radical prostatectomy in lymph node-positive patients with prostate cancer. Eur Urol 57(5):754–761. doi:10.1016/j.eururo.2009.12.034 PubMedCrossRef

28.

Pierorazio PM, Mullins JK, Eifler JB, Voth K, Hyams ES, Han M, Pavlovich CP, Bivalacqua TJ, Partin AW, Allaf ME, Schaeffer EM (2013) Contemporaneous comparison of open versus minimally-invasive radical prostatectomy for high-risk prostate cancer. BJU Int. doi:10.1111/j.1464-410X.2012.11757.x

29.

Punnen S, Meng MV, Cooperberg MR, Greene KL, Cowan JE, Carroll PR (2013) How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int. doi:10.1111/j.1464-410X.2012.11493.x

Title: Comparison of oncological outcomes between retropubic radical prostatectomy and robot-assisted radical prostatectomy: an analysis stratified by surgical experience
Authors: Jinsung Park
Dae-Seon Yoo
Cheryn Song
Sahyun Park
Sejun Park
Seong Cheol Kim
Yongmee Cho
Hanjong Ahn
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 1/2014
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-013-1168-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of oncological outcomes between retropubic radical prostatectomy and robot-assisted radical prostatectomy: an analysis stratified by surgical experience

Abstract

Objectives

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

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