OUR EARLY EXPERIENCE WITH ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY - FIRST 153 CASES
Authors:
Jan Doležel 1,2; Jaroslav Tvarůžek 2; Michal Staník 1; Radek Zachoval 2; Igor Šimoník 2; Milan Korsa 2; Václav Vagunda 3
Authors‘ workplace:
Robotické centrum Vysočina, Nemocnice sv. Zdislavy a. s., Velké Meziříčí
1; Masarykův onkologický ústav, oddělení onkourologie, Brno
2; Cedelab s. r. o., oddělení patologie, Velké Meziříčí
3
Published in:
Ces Urol 2009; 13(2): 168-177
Category:
Original article
Overview
Aim:
We present our early experience with the robot-assisted laparoscopic radical prostatectomy (RALP) in one of the four centres of robotic surgery in the Czech Republic.
Material and methods:
In the period from 1. 5. 2007 till 30. 9. 2008 we performed 153 RALP using 3 armed Da Vinci system (Intuitive surgical) in the centre of robotic surgery Vysočina. Th e operation was indicated mainly in patients with the clinically localized prostate cancer, stage cT1c was identified in 78.1%, in 20% cT2 and we operated only two patients (1.5%) with locally advanced disease. Th e mean prostate-specific antigen (PSA) value was 7.2 ng/ml (2–19 ng/ml). Preoperative Gleason score (GS) 6 or less was found in 69.3% patients, GS 7 in 27.1% and GS 8–10 in 3.6% patients. Th e average age of the patients was 63 years. In this study we evaluate operating time, blood loss, perioperative and late complications, definitive histopathology and functional outcomes. Th e mean followup is 8.5 months.
Results:
Th e mean operative skin-to-skin time was 148 (72–540) minutes and the blood loss averaged 329 (50–1500) ml. Th e pT2 stage was diagnosed in 52% and pT3 in 48% of the patients. Positive surgical margins were described in 18.7% overall, 13.6% in pT2 subgroup and 24.6% in pT3. Th e complication rate was 15% with no mortality. Patients were discharged by the fourth postoperative day in 84%. Th e catheter was removed between 8.–14. day if the postooperative course was uneventful. Immediately aft er catheter removal 25% of the patients were fully continent (0–1 pad/day), six months later in 92%. Biochemical relaps was noted in 9.2 % of the cases.
Conclusions:
Our study confirms the feasibility and safety of robot-assisted laparoscopic radical prostatectomy. It is possible to attain promising oncological and functional outcomes in a short period of time, despite of lack of experience of the operating team.
Key words:
prostate cancer, robot-assisted laparoscopic radical prostatectomy.
Sources
1. Ústav zdravotnických informací a statistiky ČR. Novotvary 2005 ČR. 2008, s. 83.
2. Catalona WJ, Han M. Definitive therapy for localized prostate cancer – an overview. In: Wein AJ, Kavoussi LR, Novick AC, PArtin AW, Peters CA. Campbell-Walsh Urology. 9.ed. Philadelphia: Saunders 2007; 2932–2946.
3. Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352: 1977–1984.
4. Tewari A, Raman JD, Chang P, et al. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology 2006; 68: 1268–1274.
5. Schuessler WW, Schulman PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology 1997; 50: 854.
6. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU 2001; 87: 408–410.
7. Patel VR, Palmer KJ, Coughlin G, Samavedi S. Robot-assisted laparoscopic radical prostatectomy: Perioperative outcomes of 1500 cases. J Endourol 2008; 22: 2299–2305.
8. Menon M, Shrivastava A, Kaul S, et al. Vattikuti institute prostatectomy: Contemporative technique and analysis of results. Eur Urol 2007; 57: 648–658.
9. Stolzenburg J, Rabenalt R, Do M, Kallidonis P, Liatsikos EN. Endoscopic extraperitoneal radical prostatectomy: Th e university of Leipzig experience of 2000 cases. J Endourol 2008; 22: 2319–2325.
10. Van Velthoven RF, Ahlering TE, Peltier A, et al. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 2003; 61: 699–702.
11. Bossi A. Modern esternal-beam radiation therapy for prostate cancer: How and when. Eur Urol Suppl 2008; 7: 22–28.
12. Swanson G, Th ompson I, Tangen C, et al. Updated results of SWOG 8794: Adjuvant radiation for high risk prostate cancer. Radiother Oncol 2008; 88(Suppl 2): 148.
13. Mattei A, Fuechsel F, Bhatta Dhar N, et al. Th e template of the primary lymphatic landing site of the prostate should be revisited: results of multimodality mapping study. Eur Urol 2008; 53: 118–125.
14. D’Amico AV, Whittington R, Malkowicz B, et al. Biochemical outcome aft er radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for localised prostate cancer. JAMA 1998; 280: 969–974.
15. Zorn KC, Gofrit ON, Orvieto MA, et al. Robotic-assisted radical prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol 2007; 51: 755–762.
16. Borin JF, Skarecky DW, Narula N, Ahlering TE. Impact of urethral stump length on continence and positive surgical margins in robot–assisted radical prostatectomy. Urology 2007; 70: 173–177.
17. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 2000; 163: 418–422.
18. Box GN, Ahlering TE. Robotic radical prostatectomy: long-term outcomes. Curr Opin Urol 2008; 18: 173–179.
19. Patel VR. European robotic urology symposium – Praha 2008. Osobní sdělení.
20. Bollens R, Sandhu S, Roumeguere T, Quackels T, Schulman C. Laparoscopic radical prostatectomy: the learning curve. Curr Opin Urol 2005; 15: 1–4.
21. Algaba F. Pitfalls of pathologic staging in prostate cancer. Eur Urol Suppl 2008; 7(1): 6–14.
22. Heidenreich A, Ohlmann CH, Polyakov S. Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol 2007; 52: 29–37.
23. Bader P, Burkhard FC, Markwalder R, et al. Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance for cure? J Urol 2003; 169: 849–854.
24. Čoupková I, Čoupek P, Šlampa P, Ondrová B, Doležel J. Adjuvantní radioterapie po radikální prostatektomii. Sborník přednášek. XV. jihočeské onkologické dny, Český Krumlov, 9.–11. 10. 2008. s. 42–43.
25. Spiotto MT, Hancock SL, King CR. Radiotherapy aft er prostatectomy:Improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys 2007; 69: 54–61.
26. Bolla M, Van Poppel H, Collette L, et al. Postoperative radiotherapy aft er radical prostatectomy: a randomized controlled trial (EORTC trial 22911). Lancet 2005; 366: 572–577.
27. Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer. A randomized clinical trial. JAMA 2006, 296: 2329–2335.
28. Van Poppel H, Goethuys H, Callewaert P, et al. Radical prostatetomy can provide a cure for a well–selected clinical stage pT3 prostate cancer. Eur Urol 2000; 38: 372–379.
29. Van Der Kwast TH, Collette L, Bolla M. Adjuvant radiotherapy aft er surgery for pathologically advanced prostate cancer. J Clin Oncol 2007; 25: 5671–5672.
30. Doležel J, Čapák I, Miklánek D, Macík D, Tvarůžek J, Šustr M, Staník M. Taktika operační léčby iatrogenních striktur membranózní uretry při ztracené sfinkterické funkci hrdla močového měchýře. Výroční konference ČUS, Hradec Králové, 8.–10. 10. 2008. Česká Urologie 2008; 12: 107 (abstrakt 41).
31. Rocco F, Carmignani L, Acquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time aft er radical retropubic prostatectomy. J Urol 2006; 175: 2201–2206.
32. Tewari AK, Bigelow K, Rao SR, et al. Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2009 Issue 2
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