EAU 2018: Perioperative outcomes of 10,000 robotic assisted radical prostatectomies. Single surgeon experience

Copenhagen, Denmark (UroToday.com) Since the advent of robotic assistance for radical prostatectomy in the early 2000’s and subsequent widespread adoption across the US, several urologist’s have amassed large personal case-series’ of robot-assisted laparoscopic radical prostatectomy (RALP). At today’s EAU 2018 annual meeting Dr. Palayapalayam Ganapathi presented perioperative outcomes of 10,000 RALPs performed by a single surgeon, the largest such sample of consecutive procedures.

These 10,000 procedures occurred between August 2002 and February of 2017. The data were collected in a prospective manner and represent the early and advanced learning curves with modifications in techniques and alterations in outcomes over time. Pre-operative, intra-operative and postoperative data were analyzed for the following parameters: patient demographics, pre-op grade and stage, intraoperative estimated blood loss (EBL), robotic console time, length of hospital stay, complications, conversion rate, surgical margins and mortality.

The median patient age undergoing surgery was 62 years (range 32-83), and mean pre-op PSA was 6.7 ng/ml (range 1-150). There was a trend towards higher grade and stage tumors over time. Pre-op cT1 disease decreased over the 10 years from 81% to 71%, while cT2 or above increased from 19% to 29%. Gleason 6 prostate cancer decreased 66% in the first 1,000 cases to 30% in the last 1,000 cases. Similarly, D’Amico low risk prostate cancer decreased from 53% to 23% and high-risk prostate cancer doubled from 11% to 22%. The median robotic console time was 75 minutes (range 35 – 240), and EBL was stable throughout the series with median 100 ml (range 25-1400). Mean hospital length of stay was 1.1 days and mean indwelling catheter time was 5.6 days. There were no conversions to open or laparoscopic prostatectomy in the series.

The 30-day mortality rate was 0.0007%, and the 30-day hospital readmission rate of 2% was primarily due to prolonged post-operative ileus, managed conservatively. The immediate reoperative rate was 0.0015% primarily for post-operative bleeding. Three cases were aborted due to extensive intra-abdominal adhesions that general surgeons were not able to negotiate. The procedure was successfully completed in 99.9% of the individuals and the overall complication rate was 6.7%. The mean OR time stabilized after 2,000 cases while length of stay, complications, margins, readmission rates and catheter time stabilized after 1,000 cases. Limitations of the study include it’s descriptive nature.

The authors concluded that RALP is a safe and effective option for localized prostate cancer. Furthermore, there has been a grade and stage migration over the series to more aggressive tumors and more complicated patients. Despite this, complication rates and oncologic outcomes have remained stable demonstrating the effect of increased experience. Long-term outcomes for cancer control, continence and sexual function will determine the overall efficacy of the procedure.

Speaker: H. Palayapalayam Ganapathi, Global Robotics Institute at Florida Hospital Celebration Health, Celebration, FL, USA

Co-Authors: Rocco B, Onol F, Roof S, Rogers T, Patel V

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark