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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2016

01-09-2016

Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy

Authors: Yosuke Hirasawa, Yoshio Ohno, Jun Nakashima, Kenji Shimodaira, Takeshi Hashimoto, Tatsuo Gondo, Makoto Ohori, Masaaki Tachibana, Kunihiko Yoshioka

Published in: Surgical Endoscopy | Issue 9/2016

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Abstract

Background

To assess the impact of preoperatively estimated prostate volume (PV) using transrectal ultrasonography (TRUS) on surgical and oncological outcomes in robot-assisted radical prostatectomy (RARP).

Methods

We analyzed the experience of a single surgeon at our hospital who performed 436 RARPs without neoadjuvant hormone therapy between August 2006 and December 2013. Patients were divided into three groups according to their preoperative PV calculated using TRUS (PV ≤ 20 cm3: group 1, n = 61; 20 < PV < 50 cm3: group 2, n = 303; PV ≥ 50 cm3: group 3, n = 72).

Results

Blood loss was significantly higher in group 3 than in group 1 and group 2. In stage pT2 patients, the rate of positive surgical margin (PSM) was significantly lower in group 3 than in group 1. In addition, perioperative complications significantly increased with increasing PV, while the extraprostatic extension (EPE) rate significantly decreased with increasing PV. The preoperative biopsy Gleason score, prostate-specific antigen (PSA) density, and clinical T2 stage were inversely correlated with increasing PV. Biochemical recurrence-free survival after RARP was significantly lower in group 1 than in groups 2 and 3.

Conclusions

A large prostate size was significantly associated with increased blood loss and a higher rate of perioperative complications. A small prostate size was associated with a higher PSM rate, PSA density, Gleason score, EPE rate, and biochemical recurrence rate. These results suggest that RARP was technically challenging in patients with large prostates, whereas small prostates were associated with unfavorable oncological outcomes.
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Metadata
Title
Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy
Authors
Yosuke Hirasawa
Yoshio Ohno
Jun Nakashima
Kenji Shimodaira
Takeshi Hashimoto
Tatsuo Gondo
Makoto Ohori
Masaaki Tachibana
Kunihiko Yoshioka
Publication date
01-09-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4664-1

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