50 Vs 50

A Comparison of the Oncologic Outcomes of Retropubic Prostatectomy and Robotic Prostatectomy Chris Ogden Tim Christmas Jordan Durrant Khalid A E Shendi Rene Woderich

Background

    The Robotic Prostatectomy Program at The Royal Marsden began in late 2006 , led by Chris Ogden.

Previously, Retropubic Prostatectomy was performed by Tim Christmas. During this Transition period, a comparison of the two methods was made.

Chris Ogden is now proctoring other Institutions making this transition.

Introduction

 Beginning on 1 cases.

st January 2007, the details of 50 consecutive Robotic Assisted Laparoscopic Prostatectomy cases were entered into a database and compared with the last 50 consecutive Radical Retropubic Prostatectomy

Methods

 Patient Data:  Age    Pre-Operative PSA, Staging, Gleason Score Pre-Operative Haemoglobin Pre-Operative MRI Staging

Methods

 Measured Outcomes were:  Anaesthetic Time     Post-Operative Haemoglobin Number of Nights in Hospital Post-Operative Histopathology Positive Margin Rate

Methods

 All patients had 12 months follow-up with 3 monthly PSA checks.

Surgical Technique

 Radical Retropubic Prostatectomy     Midline Vertical Skin Incision Bladder Neck and Nerve Preserving Yates Drain Planned In-Patient Stay of 7-10 days, TWOC prior to discharge

Surgical Technique

 Robot Assisted Laparoscopic Prostatectomy   6 ports Robinson’s drain for 12-24 hours   Planned In-Patient Stay of 1-2 days TWOC as Out-Patient at 10 days

The Patient Groups

 50 consecutive patients in each group. Non-randomised, no matching.

   Median Age   Retropubic Robotic Median PSA   Retropubic Robotic : 62 : 61   Retropubic Robotic : 8.2

: 7.1

Percentage with MRI T3 Staging Pre-Op : 6% : 8%

The Surgery

 Median Time Under Anaesthesia   Retropubic Robotic : 95 mins : 270 mins  Percentage Patients with Hb Drop > 4g/dL   Retropubic Robotic : 40% : 12%  Median Number of Post-Op Nights in Hospital   Retropubic Robotic : 9 nights : 2 nights

15 10 Mean



SEM 5 0 op en Operative Group ro bo tic p < 0.0001

 Hospital Stay (nights) Reduction in Hospital Stay significant, un paired T test shows p=<0.0001

5 4 1 0 3 2 Mean



SEM op en Operative Group ro bo tic p < 0.0002

Hb Drop (gm/100mL)  Difference in blood loss significant, un paired T test shows p=0.0002

Oncologic Outcomes

  Stage > pT3 on Final Post-Op Histology  Retropubic : 32%  Robotic : 18% Positive Margin Rate in pT2 Tumours  Retropubic : 24%  Robotic : 14%

12 Month Follow-Up

 Biochemical Recurrence in First 12 months  Retropubic : 22%  Robotic : 4%

Conclusions

 The two groups are comparable, however, the lower PSA recurrence rate in Robotic Group is in part related to lower incidence of T3 tumours.

 There are early Oncologic advantages in making the transition to Robotic Prostatectomy.

Conclusions

 The Robotic patients have a shorter hospital stay and less morbidity from blood loss.

The Future

   Our database now has over 200 cases, we look forward to presenting this data a WRS.

The data shows a consistent Positive Margin Rate of 14.7%.

27% of patients are discharged within 24 hours of surgery.

The Future

   PSA recurrence within 12 months confined to 7.6% of patients.

85% of patients pad-free at 12 months.

Median console time of 145 minutes.

The End

 Any questions?