Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes
Robotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2013-03-01
|
| Series: | Prostate International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S228788821530012X |
| _version_ | 1797716040771174400 |
|---|---|
| author | Anup A. Vora Daniel Marchalik Keith J. Kowalczyk Hannah Nissim Gaurav Bandi Kevin G. McGeagh John H. Lynch S. Reza Ghasemian Mohan Verghese Krishnan Venkatesan Phillip Borges Edward M. Uchio Jonathan J. Hwang |
| author_facet | Anup A. Vora Daniel Marchalik Keith J. Kowalczyk Hannah Nissim Gaurav Bandi Kevin G. McGeagh John H. Lynch S. Reza Ghasemian Mohan Verghese Krishnan Venkatesan Phillip Borges Edward M. Uchio Jonathan J. Hwang |
| author_sort | Anup A. Vora |
| collection | DOAJ |
| description | Robotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare our experience with RALP and ORRP in men with locally advanced PCa.
Methods: Patients with locally advanced PCa (stage T3 or greater) were identified in both robotic and open cohorts. Clinicopathologic features including age, clinical stage, prostate-specific antigen, surgical margins, and Gleason score were reviewed. We further examined the incidence of positive surgical margins, the effect of the surgical learning curve on margins, and the need for adjuvant therapy.
Results: From 1997 to 2010, 1,011 patients underwent RALP and 415 patients were identified who underwent radical retropubic prostatectomy (RRP) across four institutions. 140 patients in the RALP group and 95 in the RRP group had locally advanced PCa on final pathology. The overall robotic positive margin rate 47.1% compared with 51.4% in the RRP group. A trend towards a lower positive margin rate was seen after 300 cases in the RALP group, with 66.7% positive margin rate in the first 300 cases compared with 41.8% in the latter 700 cases. In addition, a lower incidence of biochemical recurrence was also noted in the latter cases (30.6% vs. 9.5%).
Conclusions: Up to 2 out of 3 men undergoing RALP for locally-advanced PCa had positive margins during our initial experience. However, with increasing surgeon experience the overall positive margin rate decreased significantly and was comparable to the positive margin rate for patients with locally advanced disease undergoing ORRP over four academic institutions. We also noted a lower incidence of biochemical recurrence with increasing RALP experience, suggesting better oncologic outcomes with higher volume. Given this data, RALP has comparable oncologic outcomes compared to ORRP, especially with higher volume surgeons. |
| first_indexed | 2024-03-12T08:16:40Z |
| format | Article |
| id | doaj.art-418a72e4f5434d64ba14bc104af627be |
| institution | Directory Open Access Journal |
| issn | 2287-8882 |
| language | English |
| last_indexed | 2024-03-12T08:16:40Z |
| publishDate | 2013-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Prostate International |
| spelling | doaj.art-418a72e4f5434d64ba14bc104af627be2023-09-02T18:51:14ZengElsevierProstate International2287-88822013-03-0111313610.12954/PI.12001Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomesAnup A. Vora0Daniel Marchalik1Keith J. Kowalczyk2Hannah Nissim3Gaurav Bandi4Kevin G. McGeagh5John H. Lynch6S. Reza Ghasemian7Mohan Verghese8Krishnan Venkatesan9Phillip Borges10Edward M. Uchio11Jonathan J. Hwang12Department of Urology, Washington Hospital Center, Washington, DC, USADepartment of Urology, Washington Hospital Center, Washington, DC, USADepartment of Urology, Georgetown University Hospital, Washington, DC, USADepartment of Urology, Washington Hospital Center, Washington, DC, USADepartment of Urology, Georgetown University Hospital, Washington, DC, USADepartment of Urology, Georgetown University Hospital, Washington, DC, USADepartment of Urology, Georgetown University Hospital, Washington, DC, USADepartment of Urology, Washington Hospital Center, Washington, DC, USADepartment of Urology, Washington Hospital Center, Washington, DC, USADepartment of Urology, Washington Hospital Center, Washington, DC, USADepartment of Urology, Washington DC Veterans Affairs Medical Center, Washington, DC, USADepartment of Surgery, Yale University School of Medicine, New Haven, CT, USADepartment of Urology, Washington Hospital Center, Washington, DC, USARobotic-assisted laparoscopic prostatectomy (RALP) offers reportedly comparable oncologic outcomes for localized disease compared with open radical retropubic prostatectomy (ORRP). However, the oncologic efficacy of RALP in locally-advanced prostate cancer (PCa) is less clear. We report and compare our experience with RALP and ORRP in men with locally advanced PCa. Methods: Patients with locally advanced PCa (stage T3 or greater) were identified in both robotic and open cohorts. Clinicopathologic features including age, clinical stage, prostate-specific antigen, surgical margins, and Gleason score were reviewed. We further examined the incidence of positive surgical margins, the effect of the surgical learning curve on margins, and the need for adjuvant therapy. Results: From 1997 to 2010, 1,011 patients underwent RALP and 415 patients were identified who underwent radical retropubic prostatectomy (RRP) across four institutions. 140 patients in the RALP group and 95 in the RRP group had locally advanced PCa on final pathology. The overall robotic positive margin rate 47.1% compared with 51.4% in the RRP group. A trend towards a lower positive margin rate was seen after 300 cases in the RALP group, with 66.7% positive margin rate in the first 300 cases compared with 41.8% in the latter 700 cases. In addition, a lower incidence of biochemical recurrence was also noted in the latter cases (30.6% vs. 9.5%). Conclusions: Up to 2 out of 3 men undergoing RALP for locally-advanced PCa had positive margins during our initial experience. However, with increasing surgeon experience the overall positive margin rate decreased significantly and was comparable to the positive margin rate for patients with locally advanced disease undergoing ORRP over four academic institutions. We also noted a lower incidence of biochemical recurrence with increasing RALP experience, suggesting better oncologic outcomes with higher volume. Given this data, RALP has comparable oncologic outcomes compared to ORRP, especially with higher volume surgeons.http://www.sciencedirect.com/science/article/pii/S228788821530012XProstate neoplasmsOncologic outcomesProstatectomy |
| spellingShingle | Anup A. Vora Daniel Marchalik Keith J. Kowalczyk Hannah Nissim Gaurav Bandi Kevin G. McGeagh John H. Lynch S. Reza Ghasemian Mohan Verghese Krishnan Venkatesan Phillip Borges Edward M. Uchio Jonathan J. Hwang Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes Prostate International Prostate neoplasms Oncologic outcomes Prostatectomy |
| title | Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes |
| title_full | Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes |
| title_fullStr | Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes |
| title_full_unstemmed | Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes |
| title_short | Robotic-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes |
| title_sort | robotic assisted prostatectomy and open radical retropubic prostatectomy for locally advanced prostate cancer multi institution comparison of oncologic outcomes |
| topic | Prostate neoplasms Oncologic outcomes Prostatectomy |
| url | http://www.sciencedirect.com/science/article/pii/S228788821530012X |
| work_keys_str_mv | AT anupavora roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT danielmarchalik roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT keithjkowalczyk roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT hannahnissim roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT gauravbandi roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT kevingmcgeagh roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT johnhlynch roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT srezaghasemian roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT mohanverghese roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT krishnanvenkatesan roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT phillipborges roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT edwardmuchio roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes AT jonathanjhwang roboticassistedprostatectomyandopenradicalretropubicprostatectomyforlocallyadvancedprostatecancermultiinstitutioncomparisonofoncologicoutcomes |