Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience

Abstract

Introduction: While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada. Methods: Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative. Results: The median follow-up (Q1-Q3) was 18 months (9-36). The D'Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radiotherapy and/or hormonal therapy. Conclusions: This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting. IntroductionProstate cancer is the most frequently diagnosed cancer in Canadian men, with an incidence of 104 cases/100 000 per year, and with an estimated 23 600 newly cases diagnosed in 2013. 1 In the United States, robotic-assisted radical prostatectomy (RARP) has gained increasing importance in the surgical management of prostate cancer since its first implementation in 2001.2 In 2009, 61% of these procedures were robotically assisted and in 2013, 69% to 85% of prostatectomies were performed robotically, and a minority by radical retropubic prostatectomy (RRP), perineal prostatectomy (PR) or laparoscopic radical prostatectomy (LRP). 3In Canada, however, the shift in prostatectomy practice and the growing interest for RARP is more recent, with only 20 active daVinci systems in 2013.Robotic surgery provides certain inherent advantages, including high definition 3-D vision, magnification, tremor filtration, movement scaling, and wristed instrumentation with 6-degrees of freedom.4 These features refine the surgeon's dexterity, especially when working in a narrow space like t...

Robot assisted radical prostatectomy in kidney transplant recipients: surgical, oncological and functional outcomes of two different robotic approaches

“…In general population, potency recovery rate at one year after the surgical procedure was assessed ranging from 29.6% to 77.6% (33, 34). In the current study 6 patients (66.7%) received a nerve-sparing procedure (4 bilateral, 2 monolateral), and 5 (55.6%) achieved a potency recovery, with or without PDE5i intake, sufficient to have sexual intercourses.…”

Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

“…After 3, 6 and 12 months, results were 57%, 63% and 82%, respectively (23). Using SHIM ( Sexual Health Index for Men ) questionnaire, a Canadian study with 722 cases reported recovery of sexual potency in 1, 3, 6 and 12 months of 19.5%; 31.4%; 37.2% and 52.4% (24).…”

Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

“…Over the past decade, RARP has been demonstrated as a safe procedure with acceptable oncological and functional outcomes with benefits of shorter hospital stay, convalescence and blood loss as the forefront of reduced morbidity. 9 The current guidelines define BCR as a rising PSA after surgery with two documented consecutive rises over the value of 0.2 ng/ml. 10 Radiotherapy represents a curative therapeutic option that can be offered to men with postoperative detectable PSA.…”

“…In the era of RARP, the weighted mean potency rate and the mean rate of urinary continence (no-pad) at 24 months were 64.9% and 91.4%, respectively. 9 In spite of the above-mentioned data, the possibility of post treatment deterioration should be addressed to the patients before initiation of radiotherapy. One of the important points highlighted in our study is that the…”