Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart; Laudone, Vincent P.; Wagner, Joseph R.

doi:10.4293/108680812x13462882736538

Cited by 24 publications

(26 citation statements)

References 20 publications

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“…The overall PSM rate in this series is 27.1% with a rate of 19.9% for pT2 tumors. This is comparable to other contemporaneous RARP series whose PSM rates were 6.5 - 29.5% overall and 2.5 - 22.7% in patients with stage pT2 [ 8 - 11 , 16 - 26 ]. Regarding risk factors for BCR, all four large studies referenced above agreed that the pathological Gleason score was an independent factor, but two of them did not find that the presence of positive margins was significant on multivariate analysis.…”

Section: Discussionsupporting

confidence: 83%

“…Margin status is considered an independent predictor of BCR after open radical prostatectomy in several large series [ 5 - 7 ]. This was also seen in some robotic prostatectomy series [ 8 - 11 ]. However, in the largest reported robotic series with a median follow-up of 36 months, margin status was not shown to be an independent BCR predictor [ 12 ].…”

Section: Introductionsupporting

confidence: 63%

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Risk factors for biochemical recurrence after robotic assisted radical prostatectomy: a single surgeon experience

et al. 2015

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BackgroundRadical prostatectomy is a standard surgical treatment of clinically localized prostate cancer. Margin status has been found to be an independent predictor of biochemical recurrence (BCR) after open radical prostatectomy in several large series but this is still controversy in Robotic Assisted Radical Prostatectomy (RARP) series. We therefore wanted to investigate the prognostic significance of positive surgical margin (PSM) and other pathological factors on BCR in patients treated with RARP by a single surgeon.MethodsProspectively collected data of 439 patients treated with RARP between October 2005 and June 2013 by a single surgeon at a single institution were analyzed. BCR was defined as follow-up PSA level > 0.2 ng/ml on two separate occasions or patients who had to undergo salvage therapy. Kaplan Meier curves and Log Rank test were used to compare the risk of BCR. Univariate and Multivariate Cox Regression analyses were performed to determine the prognostic impact of age, BMI, prostate weight, PSA prior to surgery, pathological T-stage, pathological Gleason sum, PSM and operative period.ResultsIn this study period, 34 out of 439 had BCR, giving an overall BCR rate of 7.7% for this cohort. Overall 2- and 3-year BCR-free survival rates were 93% and 88%, respectively. Patients with a PSM had a 2-year BCR free survival of 88% compared to 94% in those with negative margins (p < .0001). On the multivariate analysis, PSM as well as pathological Gleason sum > = 8, PSA, pathological stage and operative period were significantly associated with BCR.ConclusionsIn our case series of RARP performed by a single surgeon, PSM as well as pathological Gleason sum, PSA, pathological stage and early operative period for this surgeon were the independent predictors of BCR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0024-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionsupporting

confidence: 63%

Risk factors for biochemical recurrence after robotic assisted radical prostatectomy: a single surgeon experience

et al. 2015

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“…Our results support the view that NVB preservation during RALP is not suggested for high-risk prostate cancer due to the increased incidence of PSM. Ginzburg et al 35. reported that nerve-sparing surgical status (bilateral, unilateral, or nonnerve sparing) during RALP did not significantly affect the incidence of PSM ( P = 0.672).…”

Section: Discussionmentioning

confidence: 97%

The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China

Yang

Chang

et al. 2014

Asian J Androl

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To analyze the learning curve for cancer control from an initial 250 cases (Group I) and subsequent 250 cases (Group II) of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin (PSM) and biochemical recurrence (BCR) were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I (22.2% vs 14.2%, respectively, with Gleason score 8–10, P= 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P= 0.017). The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group II. A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle (NVB) preservation was significantly influenced by the PSM in high-risk patients (84.1% in the preservation group vs 43.9% in the nonpreservation group). The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.

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“…3 It is possible to operate more carefully and delicately with the image quality and dexterity provided by the robot. 4 In a study by Lucian et al involving transfer of laparoscopic skills to robotic surgery, it was determined that this was possible, and difficult skills especially like suturing were shown to be learned faster with robotic surgery. 9 In one study by Pauls et al involving the learning curve with comparison of robotic surgery and laparoscopy, suturing and mastering skills were found to be faster with robotic surgery compared to laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In United States, approximately 85% of radical prostatectomy operation are performed with robotics. 1,4 There is a minimal number of operations that have to be performed for certain techniques during the surgical training. Surgical experience continues to increase during the training by observing the damages inflicted on the patients.…”

mentioning

confidence: 99%

Factors Affecting Robotic Surgery and the Learning Curve

Erdemır¹,

Uygur²

2015

Turkiye Klinikleri J Urology

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Robotic surgery is a method that has been increasingly performed recently and provides a lot of convenience for the surgeon. Thirty-four prostatectomy cases performed between 2011-2013 were evaluated to share the experiences of our center related to the factors affecting robotic surgery and the evaluation of the learning curve. M Ma at te er ri ia al l a an nd d M Me et th h--o od ds s: : The cases were divided into five groups, namely: the first fifteen (Group 1a) and the last fifteen (Group 1b) cases; cases with a history of laparotomy (Group 2a, n:22) and those without history of laparotomy (Group 2b, n:12), cases with no postoperative drainage (Group 3a, n:27) and those with postoperative drainage (Group 3b, n:7); those with single operative assistant port (Group 4a, n:26) and those with double operative assistant port (Group 4b, n:8); cases with body mass index (BMI) of over 25 (overweight-obese) (Group 5a, n:27) and those with BMI of under 25 (normal weight, Group 5b, n:7); first seven (Group 6a), second seven (Group 6b), third seven (Group 6c) and last seven (Group 6d). The groups were evaluated according to the trocar time, docking time, console time, bleeding amount, specimen weight, comorbidity, incontinence and surgical margin parameters. R Re es su ul lt ts s: : In our study, it was determined that the learning curve began to build up after case fifteen, and that comorbidities, previous laparotomy, size of the prostate and obesity did not negatively affect the operation, and placing a drainage tube was not beneficial. C Co on nc cl lu us si io on n: : Obesity was determined to be an increasing factor for the bleeding during robotic surgery.K Ke ey y W Wo or rd ds s: : Robotics; learning curve; prostatic neoplasms Ö ÖZ ZE ET T A Am ma aç ç: : Robotik cerrahi gün geçtikçe kullanımı artan, cerraha birçok kolaylık sağlayan bir yöntemdir. Robotik cerrahiyi etkileyen faktörler ve öğrenme eğrisinin değerlendirilmesi yö-nünden merkezimizin tecrübelerini paylaşmak için, 2011-2014 yılları arasında yaptığımız otuzdört prostatektomi olguları değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Olgular beş gruba ayrılmış olup, ilk onbeş (Grup 1a) ve son onbeş (Grup 1b) olgular; özgeçmişinde laparotomi olmayan (Grup 2a, n:22) ve laparotomisi olan (Grup 2b, n:12); ameliyat sonunda dren konmayan (Grup 3a, n:27) ve konan (Grup 3b, n:7); asistan portu olarak tek (Grup 4a, n:26) ve çift port kullanılan (Grup 4b n:8); beden kitle indeksi 25 in üzerinde (kilolu-obez) olan (Grup 5a, n:27) ve altında olan (normal kilolu, Grup 5b, n:7); ilk yedi (Grup 6a), ikinci yedi (Grup 6b), üçüncü yedi (Grup 6c) ve son yedi (Grup 6d) olarak altı gruba ayrılmıştır. Gruplar trokar süresi, docking sü-resi, konsol süresi, kanama miktarı, spesmen ağırlığı, komorbidite, inkontinans ve cerrahi sınır parametreleri ile değerlendirilmiştir. B Bu ul lg gu ul la ar r: : Çalışmamızda öğrenme eğrisinin, onbeşinci vakadan sonra oluşmaya başladığı, komorbiditenin, geçirilmi...

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Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

Abstract: Negative surgical margins for prostate cancer patients undergoing robotic-assisted laparoscopic radical prostatectomy result in lower biochemical recurrence rates for low and intermediate risk groups.

Cited by 24 publications

References 20 publications

Risk factors for biochemical recurrence after robotic assisted radical prostatectomy: a single surgeon experience

Risk factors for biochemical recurrence after robotic assisted radical prostatectomy: a single surgeon experience

The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China

Factors Affecting Robotic Surgery and the Learning Curve

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