Outcomes of Robotic Radical Prostatectomy in High-risk Prostate Cancer Patients: Experience in 60 Patients with Oncological and Functional Outcomes

*Abdullah Erdem Canda,1 Ali Fuat Atmaca,1 Emre Urer,2 Özer Ural Çakıcı,2 Serkan Altinova,2 Ziya Akbulut,1 Mevlana Derya Balbay3

1. Department of Urology, School of Medicine, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
2. Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
3. Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey
*Correspondence to erdemcanda@yahoo.com

Disclosure: The authors have declared no conflicts of interest.
Accepted: 01.05.15
Citation: EMJ Urol. 2015;3[3]:56-59.

Abstract

Introduction: In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC), classified according to the D’Amico risk criteria and with a minimum follow-up of 1 year.
Methods: A total of 60 patients who had at least one preoperative HRPC feature and underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen level were 66.4±7.5 years and 13.4±11.0 ng/ml, respectively. Preoperatively, 3 (5.0%), 4 (6.7%), 17 (28.3%), 3 (5.0%), and 33 (55.0%) patients had prostate biopsy-proven Gleason scores of 5+4, 4+5, 4+4, 3+5, and <8, respectively. Bilateral neurovascular bundle (NVB)-sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 44 (73.3%), 3 (5.0%), and 13 (21.7%) patients, respectively.
Results: Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 159.7±62.4 minutes, 210±201.9 ml, 3.9±1.9 days, and 10.9±5.3 days, respectively. During the perioperative period (Days 0-30), 7 minor and 5 major complications occurred as categorised using the modified Clavien classification. No complications were detected during postoperative Days 31-90. Postoperative pathological stages included pT0, pT2a, pT2b, pT2c, pT3a, and pT3b disease in 2 (3.3%), 8 (13.3%), 4 (6.7%), 14 (23.3%), 18 (30.0%), and 14 (23.3%) patients, respectively. The positive surgical margin rate was 26.7% and mean lymph node yield was 11.8±8.3 (range: 3-37). Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in 13 (21.7%) patients. Of the total 60 patients, 26 (43.3%) were fully continent (0 pad/day), 15 (25.0%) wore a safety pad/day, 10 (16.7%) wore 1 pad/day, 5 (8.3%) wore 2 pads/day, and 4 (6.7%) wore >2 pads/day. Of the 27 patients with no preoperative erectile dysfunction (ED), 17 (63.0%) had no ED at a mean follow-up of 1 year. Trifecta and pentafecta rates were 43.2% and 28.7%, respectively.
Conclusion: Based on our experience, RARP in HRPC is a relatively safe procedure with satisfactory oncological and functional outcomes.

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