NARUS 2018: The Learning Curve for Surgical Margins in Retzius-Sparing Robotic Radical Prostatectomy
Methods
Consecutive RS-RARP cases were analyzed in cohorts of 40 patients, and the PSM rate was determined for pT2 and pT3 cases. The results were compared to those of a control group composed of 40 patients, after undergoing RARP using the anterior approach by the same surgeon, immediately before the start of the RS experience. All prostatectomy specimens were processed according to established guidelines and were examined by a trained Uro-Pathologist.
Results
A total of 160 patients were included in this study. The mean follow up was 8 (range 1-16) months. All 5 groups (4 study groups + 1 control group) had similar age, BMI, preoperative PSA, biopsy Gleason, clinical stage and distribution of risk categories. The results demonstrated that blood loss, transfusion rate, prostate weight and hospitalization were also similar among all groups. The mean operating time and catheter duration were shorter in the RS patients: 191 (100-300) min vs 205 (100-420) mins (p=0.05) and 9 (8-9) days vs 14 (14-14) days (p=<0.0001). PSM rates fell progressively for pT2 and pT3 tumors with increasing experience in RS groups. The PSM location and mean length were similar in all groups. The steepest part of the PSM learning curve for RS-RARP appeared to be the first 120 cases.
Conclusions
The authors concluded that there is a clear correlation between PSM and surgeon experience. Passing the 120 case cutoff, is the most important milestone.
Presented By: Pavlos Pavlakis, Royal Surrey County Hospital, Urology Department, Guildford, UK
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV