EAU 2018: What is the Learning Curve of Robot-Assisted Radical Prostatectomy in a Very High-Volume Open Radical Prostatectomy Center
From 2007 to 2015, seven very high-volume RRP surgeons (cumulative experience of 9,940 open surgeries) were consecutively trained by one surgeon at the same center in RARP, whilst continuously performing RRP. Functional and oncological outcome, Clavien complications, intraoperative and pathologic parameters were assessed for RARP and RRP, and compared in propensity matched-pair analyses. Determination of the number of surgeries to achieve oncological and functional proficiency in RARP cases was calculated. For biochemical recurrence (BCR), patients were matched based on pT-stage, PSA, pathologic Gleason score, lymph node involvement, performance of nerve sparing surgery, and pathologic margin status. For continence and potency, men were matched on age (<60, 60-70 and >70), extent of nerve-sparing (none, uni, bilateral) and prostate size. Men with neoadjuvant ADT, previous prostate cancer-treatment and postoperative radiotherapy (for continence and potency analysis) were excluded.
Results demonstrated that 2,458 (for BCR), 1,298 (for potency) and 1,504 (for continence) patients were matched 1:1 using propensity scoring between RARP and RRP. BCR-free rates, continence and potency were not statistically significantly different in RARP vs. RRP cases (all p>0.05). However, the surgeons did on average 1,149 (210-5,075) RRP vs. 262 (1-1,365) RALP, (BCR-analysis, p<0.001), 1,408 (37-5037) RRP vs. 270 (1-1343) RALP (potency analysis, p<0.001) and 1,408 (59-5,071) RRP vs. 279 (1-1,365) RALP (continence analysis, p<0.001) to achieve such comparable outcomes. Blood loss was reported with 273ml ± SD 219 for RALP vs. 785 ml ± SD 484 for RRP, and transfusion rates were 1.79% for RALP vs. 8.09% for RRP.
The learning curve of RALP with appropriate training seems to be accelerated compared to RRP. Hence robotic surgery allows for good oncologic and functional results with far less experience needed than for that of open surgery.
Presented by: Haese A, University Clinic Eppendorf, Martini-Klinik Prostate Cancer Center, Hamburg, Germany
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark