Early Complication Rates in a Single-Surgeon Series of 2500 Robotic-Assisted Radical Prostatectomies: Report Applying a Standardized Grading System

Coelho, Rafael F.; Palmer, Kenneth J.; Rocco, Bernardo; Moniz, Ravendra R.; Chauhan, Sanket; Orvieto, Marcelo A.; Coughlin, Geoff; Patel, Vipul

doi:10.1016/j.eururo.2010.02.001

Cited by 157 publications

(120 citation statements)

References 29 publications

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“…This has reduced the urethral stricture rates over the last 2 years. We have observed a very low rate of bladder neck stenosis ( n = 2; 0.4%), which compares favourably with other published series [22,23].…”

Section: © 2 0 1 0 T H E a U T H O R S 7 4 4 B J U I N T E R N A T I supporting

confidence: 78%

First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons

et al. 2010

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were T1 in 63.2%, T2 in 33.8% and T3 in 3.0% of patients. Median (range) operating time was 170 (63-420) min and median (range) blood loss was 200 (20-3000) mL, with significant improvements for both surgeons with increasing experience ( P < 0.001 and P = 0.029, respectively).• Pathological stages were pT2 in 53.4%, pT3a in 41.6%, pT3b in 4.0% and pT4 in 0.6% of patients. Overall, the positive margin rate (PMR) was 24.0% and stage-specific rates were 16.1%, 30.4%, 55.0% and 100.0% for pT2, pT3a, pT3b and pT4 disease, respectively. In the last 50 cases performed by each surgeon, the PMRs for pT2 and pT3a disease were 8.0% and 19.1% (surgeon 1) and 12.9% and 23.5% (surgeon 2).• At 12 months of follow-up, 91.3% of patients were continent and, by 48 months of follow-up, 75% of men with preoperative potency who underwent bilateral nervesparing RALP were potent. CONCLUSION• This is the first report of two surgeons' learning curves in a single centre and shows that key learning curve outcomes continued to improve during the series, suggesting that the learning curve for RALP may be longer than has been previously suggested.

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Section: © 2 0 1 0 T H E a U T H O R S 7 4 4 B J U I N T E R N A T I supporting

confidence: 78%

First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons

et al. 2010

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“…Interestingly, despite a recognized effect of experience in the 2-port RP group, oncological outcomes were similar to those in the LRP group. In the present study margin positivity rates in pT2 patients were equivalent between 2-port RP and LRP (13.3% vs 0%) and are comparable to results reported previously for LRP and RARP (Guilloneau et al, 2001;Murphy et al, 2010;Coelho et al, 2010). However, our positive margin rate in prostatic capsular penetration cases was higher than previous reports.…”

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confidence: 56%

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

Akita

Nakane²,

Ando³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy ( .6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

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“…18 Administrative data do not allow the standardized collection of complications, such as criteria defined by Martin and subsequently modified by Donat. [19][20][21][22] Specifically, claims data do not allow us to grade the severity of complications according to the Clavien classification. 23 Finally, our analyses focus on perioperative outcomes.…”

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confidence: 99%

Leapfrog volume thresholds and perioperative complications after radical prostatectomy

Trinh

Sun

Sammon

et al. 2012

Cancer

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BACKGROUND:The authors explored the effect of Leapfrog volume thresholds (LVTs) on 5 short-term radical prostatectomy (RP) outcomes. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), the authors focused on RPs performed within the 7 most contemporary years (2001)(2002)(2003)(2004)(2005)(2006)(2007). They tested rates of in-hospital mortality, intraoperative complications, postoperative complications, and blood transfusions as well as the mean length of stay (LOS), stratified according to the number of LVTs that were met. Multivariable regression analyses were adjusted further for potential confounders. RESULTS: Overall, 36.2%, 17.3%, 14.9%, 15.7%, 12.9%, and 3% of RPs were performed at institutions that reached 0 LVT, 1 LVT, 2 LVTs, 3 LVTs, 4 LVTs, and 5 LVTs, respectively. Relative to patients who underwent RP at institutions that reached 0 LVTs, patients who underwent RP at institutions that reached 5 LVTs had fewer comorbidities, were younger, were more likely to hold private insurance, and were more likely to undergo concomitant pelvic lymphadenectomy (all P < .001). In multivariable analyses adjusted for hospital volume (HV), age, race, year of surgery, Charlson Comorbidity Index, hospital region and location, pelvic lymphadenectomy, and insurance status, LVT status was related inversely to LOS and the likelihood of receiving blood transfusions (both P < .001). CONCLUSIONS: The current results indicated that LVTs can provide a highly accurate prediction of the probability of 2 important, detrimental, short-term outcomes after RP, even after accounting for HV. The benefit at institutions that meet LVTs may exceed that at other institutions when short-term RP outcomes are considered. This observation should be taken into consideration when treatment decisions are made, especially because most RPs were performed at institutions that did not meet any LVTs. Cancer 2012;118:4991-8.

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Early Complication Rates in a Single-Surgeon Series of 2500 Robotic-Assisted Radical Prostatectomies: Report Applying a Standardized Grading System

Cited by 157 publications

References 29 publications

First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons

First 500 cases of robotic‐assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons

Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

Leapfrog volume thresholds and perioperative complications after radical prostatectomy

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