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Pessoa RR, Maroni P, Kukreja J, Kim SP. Comparative effectiveness of robotic and open radical prostatectomy. Transl Androl Urol 2021; 10:2158-2170. [PMID: 34159098 PMCID: PMC8185666 DOI: 10.21037/tau.2019.12.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radical prostatectomy (RP) has undergone a remarkable transformation from open to minimally-invasive surgery over the last two decades. However, it is important to recognize there is still conflicting evidence regarding key outcomes. We aimed to summarize current literature on comparative effectiveness of robotic and open RP for key outcomes including oncologic results, health-related quality of life (HRQOL) measures, safety and postoperative complications, and healthcare costs. The bulk of the paper will discuss and interpret limitations of current data. Finally, we will also highlight future directions of both surgical approaches and its potential impact on health care delivery.
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Affiliation(s)
| | - Paul Maroni
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Janet Kukreja
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Cancer Outcomes and Public Policy Effectiveness Research (COPPER), Yale University, New Haven, Connecticut
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2
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Asimakopoulos AD, Annino F, Mugnier C, Lopez L, Hoepffner JL, Gaston R, Piechaud T. Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center. Surg Endosc 2020; 35:6731-6745. [PMID: 33289056 PMCID: PMC8599245 DOI: 10.1007/s00464-020-08177-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/15/2020] [Indexed: 11/12/2022]
Abstract
Background Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). Methods From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. Results In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. Conclusions PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.
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Affiliation(s)
- Anastasios D Asimakopoulos
- Department of Urology, Clinique Saint Augustin, Bordeaux, France. .,Department of Surgical Sciences, Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
| | - Filippo Annino
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Unit of Urology, Ospedale San Donato, Arezzo, Italy
| | - Camille Mugnier
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Laurent Lopez
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | | | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
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3
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Liu S, Hemal A. Techniques of robotic radical prostatectomy for the management of prostate cancer: which one, when and why. Transl Androl Urol 2020; 9:906-918. [PMID: 32420206 PMCID: PMC7214982 DOI: 10.21037/tau.2019.09.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The advent of robotic assistance in surgery has completely revolutionized the surgical management of prostate cancer. It enables precise dissection and reconstruction in order to maximize oncological and functional outcomes. In many parts of the world, robot-assisted laparoscopic radical prostatectomy has evolved to become the surgical standard of care for localized disease, including in appropriately selected patients with high risk prostate cancer. Its role has also been expanded to encompass cytoreductive prostatectomy and salvage radical prostatectomy. As surgical expertise grows with robotic assistance, several novel and non-radical approaches have been developed to further mitigate treatment side effects. Patient characteristics, disease factors and surgeon expertise are important metrics for consideration when selecting the most appropriate technique for any given patient.
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Affiliation(s)
- Shuo Liu
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Ashok Hemal
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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4
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Martini A, Gupta A, Cumarasamy S, Tewari AK. Re: Rita Faria, Marta O. Soares, Eldon Spackman, et al. Optimising the Diagnosis of Prostate Cancer in the Era of Multiparametric Magnetic Resonance Imaging: A Cost-effectiveness Analysis Based on the Prostate MR Imaging Study (PROMIS). Eur Urol 2018;73:23–30. Eur Urol 2018; 73:e108-e109. [DOI: 10.1016/j.eururo.2017.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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5
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Phillips H, Ellison GW, Mathews KG, Aronson LR, Schmiedt CW, Robello G, Selmic LE, Gregory CR. Validation of a model of feline ureteral obstruction as a tool for teaching microsurgery to veterinary surgeons. Vet Surg 2018; 47:357-366. [DOI: 10.1111/vsu.12769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 10/01/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Heidi Phillips
- Department of Veterinary Clinical Medicine; University of Illinois at Urbana-Champaign; Urbana Illinois
| | - Gary W. Ellison
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville Florida
| | - Kyle G. Mathews
- Department of Clinical Sciences; North Carolina State University; Raleigh North Carolina
| | - Lillian R. Aronson
- Department of Clinical Studies; University of Pennsylvania; Philadelphia Pennsylvania
| | - Chad W. Schmiedt
- Department of Small Animal Medicine and Surgery; University of Georgia; Athens Georgia
| | - Gil Robello
- PetCare Veterinary Hospital; Santa Rosa California
| | - Laura E. Selmic
- Department of Veterinary Clinical Medicine; University of Illinois at Urbana-Champaign; Urbana Illinois
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6
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Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review. Ann Diagn Pathol 2016; 24:11-8. [DOI: 10.1016/j.anndiagpath.2016.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022]
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7
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Canda AE, Balbay MD. Robotic radical prostatectomy in high-risk prostate cancer: current perspectives. Asian J Androl 2016; 17:908-15; discussion 913. [PMID: 25994643 PMCID: PMC4814968 DOI: 10.4103/1008-682x.153541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Around 20%–30% of patients diagnosed with prostate cancer (PCa) still have high-risk PCa disease (HRPC) that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP) in HRPC and currently, robot-assisted laparoscopic RP (RARP) has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN) yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results.
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Affiliation(s)
- Abdullah Erdem Canda
- Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospital, Department of Urology, Ankara, Turkey
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8
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Lee HW, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY. Is Radical Perineal Prostatectomy a Viable Therapeutic Option for Intermediate- and High-risk Prostate Cancer? J Korean Med Sci 2015; 30:1631-7. [PMID: 26539008 PMCID: PMC4630480 DOI: 10.3346/jkms.2015.30.11.1631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/07/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA > 20 ng/mL, bGS ≥ 8, or ≥ cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.
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Affiliation(s)
- Hye Won Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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9
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Tewari AK. Erratum. BJU Int 2015; 116:E3. [DOI: 10.1111/bju.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ashutosh K. Tewari
- Department of Urology; Weill Medical College of Cornell University; 525 East 68th Street Starr 900 New York NY 10065 USA
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10
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Lightfoot AJ, Su YK, Sehgal SS, Lee Z, Greaves GH, Yu SJS, Llukani E, Su YC, Lee DI. Positive Surgical Margin Trends in Patients with Pathologic T3 Prostate Cancer Treated with Robot-Assisted Radical Prostatectomy. J Endourol 2015; 29:634-9. [DOI: 10.1089/end.2014.0242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew J. Lightfoot
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu-Kai Su
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shailen S. Sehgal
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ziho Lee
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giovanni H. Greaves
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sue-Jean S. Yu
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elton Llukani
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu-Chen Su
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I. Lee
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Liu M, Curet M. A review of training research and virtual reality simulators for the da Vinci surgical system. TEACHING AND LEARNING IN MEDICINE 2015; 27:12-26. [PMID: 25584468 DOI: 10.1080/10401334.2014.979181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. APPROACH This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. FINDINGS An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.
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Affiliation(s)
- May Liu
- a Medical Research Department , Intuitive Surgical, Inc. , Sunnyvale , California , USA
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12
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Pisipati S, Ali A, Mandalapu RS, Haines Iii GK, Singhal P, Reddy BN, Leung R, Tewari AK. Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy. Indian J Urol 2014; 30:399-409. [PMID: 25378822 PMCID: PMC4220380 DOI: 10.4103/0970-1591.142064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
With more than 60% of radical prostatectomies being performed robotically, robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced the open and laparoscopic approaches and has become the standard of care surgical treatment option for localized prostate cancer in the United States. Accomplishing negative surgical margins while preserving functional outcomes of sexual function and continence play a significant role in determining the success of surgical intervention, particularly since the advent of nerve-sparing (NS) robotic prostatectomy. Recent evidence suggests that NS surgery improves continence in addition to sexual function. In this review, we describe the neuroanatomical concepts and recent developments in the NS technique of RALP with a view to improving the “trifecta” outcomes.
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Affiliation(s)
- Sailaja Pisipati
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - Adnan Ali
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - Rao S Mandalapu
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - George K Haines Iii
- Department of Pathology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - Paras Singhal
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - Balaji N Reddy
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - Robert Leung
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA
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13
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Lightfoot AJ, Su YK, Sehgal SS, Lee Z, Greaves GH, Yu SJS, Llukani E, Su YC, Lee D. Positive Surgical Margin Trends In Patients With Pathologic T3 Prostate Cancer Treated With Robot Assisted Radical Prostatectomy. J Endourol 2014. [DOI: 10.1089/end.2014.0242.ecc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Sood A, Jeong W, Peabody JO, Hemal AK, Menon M. Robot-assisted radical prostatectomy: inching toward gold standard. Urol Clin North Am 2014; 41:473-84. [PMID: 25306159 DOI: 10.1016/j.ucl.2014.07.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Robot-assisted radical prostatectomy (RARP) offers excellent and lasting oncologic control. Technical refinements in apical dissection, such as the retroapical approach of synchronous urethral transection, and adoption of real-time frozen section analysis of the excised prostate during RARP have substantially reduced positive surgical margin rates, particularly in high-risk disease patients. Furthermore, precision offered by the robotic platform and technical evolution of radical prostatectomy, including enhanced nerve sparing (veil), have led to improved potency and continence outcomes as well as better safety profile in patients undergoing surgical therapy for prostate cancer.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, Medical Center Boulevard, NC 27157-1090, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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15
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Surcel CI, Sooriakumaran P, Briganti A, De Visschere PJ, Fütterer JJ, Ghadjar P, Isbarn H, Ost P, Ploussard G, van den Bergh RC, van Oort IM, Yossepowitch O, Sedelaar JM, Giannarini G. Preferences in the management of high-risk prostate cancer among urologists in Europe: results of a web-based survey. BJU Int 2014; 115:571-9. [DOI: 10.1111/bju.12796] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cristian I. Surcel
- Centre of Uronephrology and Renal Transplantation; Fundeni Clinical Institute; “Carol Davila” University of Medicine and Pharmacy; Bucharest Romania
| | - Prasanna Sooriakumaran
- Surgical Intervention Trials Unit; Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
- Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Alberto Briganti
- Department of Urology; Urological Research Institute; Vita-Salute University San Raffaele; Milan
| | | | - Jurgen J. Fütterer
- Department of Radiology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Pirus Ghadjar
- Department of Radiation Oncology; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Hendrik Isbarn
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research; Ghent University Hospital; Ghent Belgium
| | - Guillaume Ploussard
- Department of Urology; CHU Saint-Louis; Assistance Publique - Hôpitaux de Paris; Université Paris Est Creteil; Paris France
| | | | - Inge M. van Oort
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Ofer Yossepowitch
- Department of Urology; Rabin Medical Center - Beilinson; Petach-Tikva Israel
- Sackler Faculty of Medicine; University of Tel Aviv; Tel Aviv Israel
| | | | - Gianluca Giannarini
- Department of Experimental and Clinical Medical Sciences; Urology Unit, University of Udine; Udine Italy
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16
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Abstract
Positive surgical margins after radical prostatectomy Positive surgical margins (PSMs) in radical prostatectomy specimens are usually considered a negative prognostic parameter. However, their definition and the management of patients with PSMs remain unclear. The aim of the present review is to define pathological features of PSMs, to report their incidence and risk factors and to update PSMs prognostic meaning and possible treatment modalities. The average incidence of PSMs in contemporary series ranges from 6.5% to 32%. The likelihood of PSMs is influenced by pre-operative PSA (total-PSA and PSA-density), tumor features (volume, grade and stage), previous prostatic surgery (open or TURP), patients’ characteristics (BMI and pelvis shape) and surgeons’ skill. Although PSMs are a predictor of biochemical recurrence, their impact on cause specific survival is highly variable and largely influenced by the tumor Gleason Score. Adjuvant radiotherapy is an effective treatment in PSMs patients but early salvage radiotherapy may be an alternative option that guarantees equivalent survival benefits with less side effects. Further studies are required to define the best candidates to adjuvant or early salvage radiation therapy.
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17
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Hu JC, Gandaglia G, Karakiewicz PI, Nguyen PL, Trinh QD, Shih YCT, Abdollah F, Chamie K, Wright JL, Ganz PA, Sun M. Comparative effectiveness of robot-assisted versus open radical prostatectomy cancer control. Eur Urol 2014; 66:666-72. [PMID: 24602934 DOI: 10.1016/j.eururo.2014.02.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) remains controversial, and no improvement in cancer control outcomes has been demonstrated over open radical prostatectomy (ORP). OBJECTIVE To examine population-based, comparative effectiveness of RARP versus ORP pertaining surgical margin status and use of additional cancer therapy. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective observational study of 5556 RARP and 7878 ORP cases from 2004 to 2009 from Surveillance Epidemiology and End Results-Medicare linked data. INTERVENTION RARP versus ORP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of RP surgical margin status and use of additional cancer therapy (radiation therapy [RT] or androgen deprivation therapy [ADT]) by surgical approach. RESULTS AND LIMITATIONS In the propensity-adjusted analysis, RARP was associated with fewer positive surgical margins (13.6% vs 18.3%; odds ratio [OR]: 0.70; 95% confidence interval [CI], 0.66-0.75), largely because of fewer RARP positive margins for intermediate-risk (15.0% vs 21.0%; OR: 0.66; 95% CI, 0.59-0.75) and high-risk (15.1% vs 20.6%; OR: 0.70; 95% CI, 0.63-0.77) disease. In addition, RARP was associated with less use of additional cancer therapy within 6 mo (4.5% vs 6.2%; OR: 0.75; 95% CI, 0.69-0.81), 12 mo (OR: 0.73; 95% CI, 0.62-0.86), and 24 mo (OR: 0.67; 95% CI, 0.57-0.78) of surgery. Limitations include the retrospective nature of the study and the absence of prostate-specific antigen levels to determine biochemical recurrence. CONCLUSIONS RARP is associated with improved surgical margin status relative to ORP for intermediate- and high-risk disease and less use of postprostatectomy ADT and RT. This has important implications for quality of life, health care delivery, and costs. PATIENT SUMMARY Robot-assisted radical prostatectomy (RP) versus open RP is associated with fewer positive margins and better early cancer control because of less use of additional androgen deprivation and radiation therapy within 2 yr of surgery.
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Affiliation(s)
- Jim C Hu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Giorgio Gandaglia
- Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, Universita Vita-Salute San Raffaele, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ya-Chen Tina Shih
- Section of Hospital Medicine, Department of Medicine Program in the Economics of Cancer, University of Chicago, Chicago, IL, USA
| | - Firas Abdollah
- Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Patricia A Ganz
- Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center, Fielding School of Public Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maxine Sun
- Cancer Prognostics Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
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Sooriakumaran P, Wiklund P, Roobol MJ, Steyerberg E, Sanchez-Salas R, Cathelineau X, Tewari AK. Reply to Gianluca Giannarini, Nazareno Suardi and Alberto Briganti's letter to the editor re: Prasanna Sooriakumaran, Abhishek Srivastava, Shahrokh F. Shariat, et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22 393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2013.11.018. Eur Urol 2014; 65:e91-2. [PMID: 24447573 DOI: 10.1016/j.eururo.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Prasanna Sooriakumaran
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Monique J Roobol
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Fode M, Sønksen J, Jakobsen H. Radical prostatectomy: initial experience with robot-assisted laparoscopic procedures at a large university hospital. Scand J Urol 2013; 48:252-8. [PMID: 24341725 DOI: 10.3109/21681805.2013.868514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. MATERIAL AND METHODS Patient and tumour characteristics, surgeon, nerve sparing, surgical margins and blood loss were recorded prospectively in patients who underwent RRP or RALP between April 2008 and May 2012. Patients filled out the Danish Prostate Symptom Score (DAN-PSS) and International Index of Erectile Function 5 (IIEF-5) questionnaires before surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood loss and functional outcomes were compared between groups. RESULTS Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone RRP had an increased chance of reporting subjective continence at 12 months (odds ratio 2.6, p = 0.014). There was no difference in the proportion of RRP and RALP patients who underwent surgical treatment for incontinence (p = 0.57). On multivariate linear regression analysis, RALP was an independent predictor of a low perioperative blood loss (RRP:RALP ratio = 2.89, p < 0.0001). CONCLUSIONS RALP is a safe procedure with regard to perioperative and oncological results. However, it is important to be aware that functional outcomes may be compromised in the initial phase when introducing RALP.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Herlev Hospital , Herlev , Denmark
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Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R, Touijer K. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 2013; 65:303-13. [PMID: 23932439 DOI: 10.1016/j.eururo.2013.07.039] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 07/25/2013] [Indexed: 02/03/2023]
Abstract
CONTEXT The clinical significance of positive surgical margins (PSMs) in radical prostatectomy (RP) specimens and the management of affected patients remain unclear. OBJECTIVE To address pitfalls in the pathologic interpretation of margin status; provide an update on the incidence, predictors, and long-term oncologic implications of PSMs in the era of robot-assisted laparoscopic RP (RALRP); and suggest a practical evidence-based approach to patient management. EVIDENCE ACQUISITION A systematic review of the literature was performed in April 2013 using Medline/PubMed, Web of Science, and Scopus databases and the Cochrane Database of Systematic Reviews. Studies focusing on PSMs in RP pertinent to the objectives of this review were included. Particular attention was paid to publications within the last 5 yr and those concerning RALRP. EVIDENCE SYNTHESIS A total of 74 publications were retrieved. Standardized measures to overcome variability in the pathologic interpretation of surgical margins have recently been established by the International Society of Urological Pathology. The average rate of PSMs in contemporary RALRP series is 15% (range: 6.5-32%), which is higher in men with a more advanced pathologic stage and equivalent to the rate reported in prior open and laparoscopic prostatectomy series. The likelihood of PSMs is strongly influenced by the surgeon's experience irrespective of the surgical approach. Technical modifications using the robotic platform and the role of frozen-section analysis to reduce the margin positivity rate continue to evolve. Positive margins are associated with a twofold increased hazard of biochemical relapse, but their association with more robust clinical end points is controversial. Level 1 evidence suggests that adjuvant radiation therapy (RT) may favorably affect prostate-specific antigen recurrence rates, but whether the therapy also affects systemic progression, prostate cancer-specific mortality, and overall survival remains debatable. CONCLUSIONS Although positive margins in prostate cancer are considered an adverse oncologic outcome, their long-term impact on survival is highly variable and largely influenced by other risk modifiers. Adjuvant RT appears to be effective, but further study is required to determine whether early salvage RT is an equivalent alternative.
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Affiliation(s)
- Ofer Yossepowitch
- Department of Urology, Rabin Medical Center, Petach-Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alberto Briganti
- Department of Urology, Università Vita Salute San Raffaele, Milan, Italy
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jonathan Epstein
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Markus Graefen
- Martini Clinic, Prostate Cancer Center, University of Hamburg, Hamburg, Germany
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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21
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Glass AS, Punnen S, Cooperberg MR. Divorcing diagnosis from treatment: contemporary management of low-risk prostate cancer. Korean J Urol 2013; 54:417-25. [PMID: 23878682 PMCID: PMC3715703 DOI: 10.4111/kju.2013.54.7.417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/20/2013] [Indexed: 12/24/2022] Open
Abstract
Today, the majority of men with newly diagnosed prostate cancer will present with low-risk features of the disease. Because prostate cancer often takes an insidious course, it is debated whether the majority of these men require radical treatment and the accompanying derangement of quality of life domains imposed by surgery, radiation, and hormonal therapy. Investigators have identified various selection criteria for "insignificant disease," or that which can be monitored for disease progression while safely delaying radical treatment. In addition to the ideal definition of low risk, a lack of randomized trials comparing the various options for treatment in this group of men poses a great challenge for urologists. Early outcomes from active surveillance cohorts support its use in carefully selected men with low-risk disease features, but frequent monitoring is required. Patient selection and disease monitoring methods will require refinement that will likely be accomplished through the increased use of biomarkers and specialized imaging techniques.
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Affiliation(s)
- Allison S Glass
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
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22
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Wambi CO, Patel T, Shapiro EY, Tal O, Hruby GW, Berg WT, Benson MC, Badani KK. Findings of Routine Apical Margin Biopsy During Robot-Assisted Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2013; 23:511-5. [DOI: 10.1089/lap.2012.0417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chris O. Wambi
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Trushar Patel
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Edan Y. Shapiro
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Oded Tal
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Greg W. Hruby
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - William T. Berg
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Mitchell C. Benson
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Ketan K. Badani
- Department of Urology, New York Presbyterian Hospital, Columbia University, New York, New York
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Masrur M, Gheza F, Raimondi P, D'Ugo S, Calatayud D, Giulianotti PC. Robot-assisted subtotal pancreas-preserving duodenectomy. JSLS 2013; 16:654-9. [PMID: 23484581 PMCID: PMC3558909 DOI: 10.4293/108680812x13517013316591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance. METHODS The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy. RESULTS The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage. CONCLUSION The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery.
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Affiliation(s)
- Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois, Chicago, IL 60612, USA.
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Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol 2013; 63:438-44. [DOI: 10.1016/j.eururo.2012.07.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022]
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25
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Røder MA, Thomsen FB, Christensen IJ, Toft BG, Brasso K, Vainer B, Iversen P. Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: Can nerve-sparing surgery increase the risk? Scand J Urol 2012. [DOI: 10.3109/00365599.2012.749425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Next-generation prostate cancer biobanking: toward a processing protocol amenable for the International Cancer Genome Consortium. ACTA ACUST UNITED AC 2012; 21:61-8. [PMID: 22555088 DOI: 10.1097/pdm.0b013e31823b6da6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Next-generation DNA and RNA sequencing requires intact nucleic acids from high-quality human tissue samples to better elucidate the molecular basis of cancer. We have developed a prostate biobanking protocol to acquire suitable samples for sequencing without compromising the accuracy of clinical diagnosis. To assess the clinical implications of implementing this protocol, we evaluated 105 consecutive radical prostatectomy specimens from November 2008 to February 2009. Alternating levels of prostate samples were submitted to Surgical Pathology as formalin-fixed, paraffin-embedded blocks and to the institutional biobank as frozen blocks. Differences in reported pathologic characteristics between clinical and procured specimens were compared. Clinical staging and grading were not affected by the biobank protocol. Tumor foci on frozen hematoxylin and eosin slides were identified and high-density tumor foci were scored and processed for DNA and RNA extractions for sequencing. Both DNA and RNA were extracted from 22 cases of 44 with high-density tumor foci. Eighty-two percent (18/22) of the samples passed rigorous quality control steps for DNA and RNA sequencing. To date, DNA extracted from 7 cases has undergone whole-genome sequencing, and RNA from 18 cases has been RNA sequenced. This protocol provides prostate tissue for high-throughput biomedical research and confirms the feasibility of actively integrating prostate cancer into The Cancer Genome Atlas Program, a member of the International Cancer Genome Consortium.
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Sugden C, Athanasiou T, Darzi A. What Are the Effects of Sleep Deprivation and Fatigue in Surgical Practice? Semin Thorac Cardiovasc Surg 2012. [DOI: 10.1053/j.semtcvs.2012.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Tewari A, Pham A, Srivastava A, Leung R, Sooriakumaran P, Bloch D, Seshadri-Kreaden U, Hebert AE, Wiklund P. Reply from Authors re: Quoc-Dien Trinh, Khurshid R. Ghani, Mani Menon. Robot-assisted Radical Prostatectomy: Ready To Be Counted? Eur Urol 2012;62:16–8. Eur Urol 2012. [DOI: 10.1016/j.eururo.2012.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, Guazzoni G, Menon M, Patel VR, Shariat SF, Tewari AK, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Rosen RC, Wilson TG. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62:382-404. [PMID: 22749851 DOI: 10.1016/j.eururo.2012.05.047] [Citation(s) in RCA: 350] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited. OBJECTIVE Evaluate lymph node yield, positive surgical margins (PSMs), use of adjuvant therapy, and biochemical recurrence (BCR)-free survival following RARP and perform a cumulative analysis of all studies comparing the oncologic outcomes of RARP and retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). EVIDENCE ACQUISITION A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK) and Stata 11.0 SE software (StataCorp, College Station, TX, USA). EVIDENCE SYNTHESIS We retrieved 79 papers evaluating oncologic outcomes following RARP. The mean PSM rate was 15% in all comers and 9% in pathologically localized cancers, with some tumor characteristics being the most relevant predictors of PSMs. Several surgeon-related characteristics or procedure-related issues may play a major role in PSM rates. With regard to BCR, the very few papers with a follow-up duration >5 yr demonstrated 7-yr BCR-free survival estimates of approximately 80%. Finally, all the cumulative analyses comparing RARP with RRP and comparing RARP with LRP demonstrated similar overall PSM rates (RARP vs RRP: odds ratio [OR]: 1.21; p=0.19; RARP vs LRP: OR: 1.12; p=0.47), pT2 PSM rates (RARP vs RRP: OR: 1.25; p=0.31; RARP vs LRP: OR: 0.99; p=0.97), and BCR-free survival estimates (RARP vs RRP: hazard ratio [HR]: 0.9; p=0.526; RARP vs LRP: HR: 0.5; p=0.141), regardless of the surgical approach. CONCLUSIONS PSM rates are similar following RARP, RRP, and LRP. The few data available on BCR from high-volume centers are promising, but definitive comparisons with RRP or LRP are not currently possible. Finally, significant data on cancer-specific mortality are not currently available.
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Abstract
PURPOSE OF REVIEW Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to evaluate the important considerations in developing a new robotics program at a given healthcare institution. RECENT FINDINGS Patients' interest in robotic-assisted surgery has and continues to grow because of improved outcomes and decreased periods of hospitalization. Resulting market forces have created a solid foundation for the implementation of robotic surgery into surgical practice. Given proper surgeon experience and an efficient system, robotic-assisted procedures have been cost comparable to open surgical alternatives. Surgeon training and experience is closely linked to the efficiency of a new robotics program. Formally trained robotic surgeons have better patient outcomes and shorter operative times. Training in robotics has shown no negative impact on patient outcomes or mentor learning curves. SUMMARY Individual economic factors of local healthcare settings must be evaluated when planning for a new robotics program. The high cost of the robotic surgical platform is best offset with a large surgical volume. A mature, experienced surgeon is integral to the success of a new robotics program.
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Anatomic Grading of Nerve Sparing During Robot-Assisted Radical Prostatectomy. Eur Urol 2012; 61:796-802. [DOI: 10.1016/j.eururo.2011.12.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/23/2011] [Indexed: 11/23/2022]
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Chopra S, Srivastava A, Tewari A. Robotic radical prostatectomy: The new gold standard. Arab J Urol 2012; 10:23-31. [PMID: 26558001 PMCID: PMC4442908 DOI: 10.1016/j.aju.2011.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/21/2011] [Accepted: 12/24/2011] [Indexed: 11/15/2022] Open
Abstract
Objectives Open radical prostatectomy (RP) has been the standard and primary treatment for focal prostate cancer. However, in recent years this view has changed, as robot-assisted laparoscopic RP has gained acceptance among urologists. In this review we evaluate the importance and place of robotics in laparoscopic urological surgery, discussing several techniques that are currently being used and potentially new techniques that might be used in the future. Methods We systematically reviewed papers published between 1998 and 2011 using the keywords ‘robotic prostatectomy’ ‘gold standard’ and the Medline database. In addition, after selecting relevant reports we searched ‘related citations’ of the documents to find further supporting published papers. Results In all, 50 original papers were identified using the search criteria; we also found 28 through ‘related citations’ browsing. Papers were selected according to their relevance to the current topic (i.e. RP, original articles) and incorporated into this review. These papers were used for their information on the advantages of using robotics, as well as innovative ideas being used in the field of robotic urological surgery. Conclusion Almost a decade after the first robotic RP many reports show the benefits and advantages of incorporating robotics into urological surgery. Robotic surgery decreases the learning curve necessary for surgeons when compared with laparoscopic techniques. In addition, patients prefer robotics, as the procedure is less invasive, diminishes the duration of hospitalisation and speeds the return to function.
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Affiliation(s)
- Sameer Chopra
- LeFrak Institute of Robotic Surgery and Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, NY, USA
| | - Abhishek Srivastava
- LeFrak Institute of Robotic Surgery and Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, NY, USA
| | - Ashutosh Tewari
- LeFrak Institute of Robotic Surgery and Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, NY, USA
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Yamamoto T, Abolhassani N, Jung S, Okamura AM, Judkins TN. Augmented reality and haptic interfaces for robot-assisted surgery. Int J Med Robot 2011; 8:45-56. [DOI: 10.1002/rcs.421] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/20/2011] [Accepted: 07/08/2011] [Indexed: 01/08/2023]
Affiliation(s)
- Tomonori Yamamoto
- Department of Mechanical Engineering; Johns Hopkins University; Baltimore; MD; USA
| | - Niki Abolhassani
- Robotics and ElectroMechanical Systems; Intelligent Automation Inc.; Rockville; MD; USA
| | - Sung Jung
- Robotics and ElectroMechanical Systems; Intelligent Automation Inc.; Rockville; MD; USA
| | - Allison M. Okamura
- Department of Mechanical Engineering; Johns Hopkins University; Baltimore; MD; USA
| | - Timothy N. Judkins
- Robotics and ElectroMechanical Systems; Intelligent Automation Inc.; Rockville; MD; USA
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Stroup SP, Kane CJ. Robotic-assisted laparoscopic prostatectomy for high-risk prostate cancer: technical considerations and review of the literature. ISRN UROLOGY 2011; 2011:201408. [PMID: 22084791 PMCID: PMC3196353 DOI: 10.5402/2011/201408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/02/2011] [Indexed: 11/23/2022]
Abstract
Men with high-risk prostate cancer are at significant risk of progressive, symptomatic disease leading to metastases or death from prostate cancer. Surgery-specifically robotic-assisted laparoscopic prostatectomy (RALP)-is increasingly being considered as a key component of a multimodal strategy to treat these patients. Herein, we review key technical considerations of performing RALP with bilateral pelvic lymphadenectomy in men with high-risk disease. Recent literature supporting the increasing role of surgery either alone or in combination with adjuvant therapies to treat men with high-risk prostate cancer is also reviewed.
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Affiliation(s)
- Sean P Stroup
- Division of Urology, University of California, 200 West Arbor Drive 8897, San Diego, CA 92103-8897, USA
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Challacombe B. First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single uk centre: learning curves of two surgeons. BJU Int 2011; 108:747-8. [PMID: 21854528 DOI: 10.1111/j.1464-410x.2011.10501.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tewari A, Srivastava A, Sooriakumaran P, Grover S, Dorsey P, Leung R. Technique of traction-free nerve-sparing robotic prostatectomy: delicate tissue handling by real-time penile oxygen monitoring. Int J Impot Res 2011; 24:11-9. [DOI: 10.1038/ijir.2011.40] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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37
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Current world literature. Curr Opin Urol 2011; 21:257-64. [PMID: 21455039 DOI: 10.1097/mou.0b013e3283462c0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neuroanatomic basis for traction-free preservation of the neural hammock during athermal robotic radical prostatectomy. Curr Opin Urol 2011; 21:49-59. [DOI: 10.1097/mou.0b013e32834120e9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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39
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Current world literature. Curr Opin Urol 2010; 21:84-91. [PMID: 21127406 DOI: 10.1097/mou.0b013e328341a1a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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