50 50 VsVs 50 50

A Comparison of the Oncologic A Comparison of the Oncologic Outcomes of Retropubic Outcomes of Retropubic

Prostatectomy and Robotic Prostatectomy and Robotic ProstatectomyProstatectomyChris Ogden

Tim ChristmasJordan DurrantKhalid A E ShendiRene Woderich

BackgroundBackground

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

Previously, Retropubic Prostatectomy was Previously, Retropubic Prostatectomy was performed by Tim Christmas. performed by Tim Christmas.

During this Transition period, a comparison During this Transition period, a comparison of the two methods was made.of the two methods was made.

Chris Ogden is now proctoring other Chris Ogden is now proctoring other Institutions making this transition.Institutions making this transition.

IntroductionIntroduction

Beginning on 1Beginning on 1stst January 2007, the details January 2007, the details of 50 consecutive Robotic Assisted of 50 consecutive Robotic Assisted Laparoscopic Prostatectomy cases were Laparoscopic Prostatectomy cases were entered into a database and compared with entered into a database and compared with the last 50 consecutive Radical Retropubic the last 50 consecutive Radical Retropubic Prostatectomy cases.Prostatectomy cases.

MethodsMethods Patient Data:Patient Data:

AgeAge Pre-Operative PSA, Pre-Operative PSA,

Staging, Gleason ScoreStaging, Gleason Score Pre-Operative Pre-Operative

HaemoglobinHaemoglobin Pre-Operative MRI StagingPre-Operative MRI Staging

MethodsMethods

Measured Measured Outcomes were:Outcomes were: Anaesthetic TimeAnaesthetic Time Post-Operative Post-Operative

HaemoglobinHaemoglobin Number of Nights in Number of Nights in

HospitalHospital Post-Operative Post-Operative

HistopathologyHistopathology Positive Margin Positive Margin

RateRate

MethodsMethods

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

Surgical TechniqueSurgical Technique

Radical Retropubic ProstatectomyRadical Retropubic Prostatectomy Midline Vertical Skin IncisionMidline Vertical Skin Incision Bladder Neck and Nerve PreservingBladder Neck and Nerve Preserving Yates DrainYates Drain Planned In-Patient Stay of 7-10 days, Planned In-Patient Stay of 7-10 days,

TWOC prior to dischargeTWOC prior to discharge

Surgical TechniqueSurgical Technique

Robot Assisted Robot Assisted Laparoscopic Laparoscopic ProstatectomyProstatectomy 6 ports6 ports Robinson’s drain for 12-Robinson’s drain for 12-

24 hours24 hours Planned In-Patient Stay Planned In-Patient Stay

of 1-2 daysof 1-2 days TWOC as Out-Patient at TWOC as Out-Patient at

10 days10 days

The Patient GroupsThe Patient Groups

Median AgeMedian Age Retropubic Retropubic : 62: 62 Robotic Robotic : 61: 61

Median PSA Median PSA RetropubicRetropubic : 8.2: 8.2 RoboticRobotic : 7.1: 7.1

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

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

The SurgeryThe Surgery Median Time Under Median Time Under

AnaesthesiaAnaesthesia RetropubicRetropubic : 95 mins: 95 mins RoboticRobotic : 270 : 270

minsmins Percentage Patients with Percentage Patients with

Hb Drop Hb Drop >> 4g/dL4g/dL RetropubicRetropubic : 40%: 40% RoboticRobotic : 12%: 12%

Median Number of Post-Op Median Number of Post-Op Nights in HospitalNights in Hospital RetropubicRetropubic : 9 nights: 9 nights RoboticRobotic : 2 : 2

nightsnights

Reduction in Hospital Stay significant, Reduction in Hospital Stay significant, un-paired T test shows p=<0.0001un-paired T test shows p=<0.0001

0

5

10

15Mean SEM

p < 0.0001

Hospital Stay (nights)

Operative Group

Mea

n o

f H

osp

ital

Sta

y (n

igh

ts)

Difference in blood loss significant, Difference in blood loss significant, un-paired T test shows p=0.0002un-paired T test shows p=0.0002

0

1

2

3

4

5Mean SEM

p < 0.0002

Hb Drop (gm/100mL)

Operative Group

Hb

Dro

p (

gm

/100 m

L)

Oncologic OutcomesOncologic Outcomes

Stage Stage >> pT3 on Final pT3 on Final Post-Op HistologyPost-Op Histology RetropubicRetropubic : 32%: 32% RoboticRobotic : 18%: 18%

Positive Margin Rate Positive Margin Rate in pT2 Tumoursin pT2 Tumours RetropubicRetropubic : 24%: 24% RoboticRobotic : 14%: 14%

12 Month Follow-Up12 Month Follow-Up

Biochemical Biochemical Recurrence in First Recurrence in First 12 months12 months RetropubicRetropubic : 22%: 22% RoboticRobotic : :

4%4%

ConclusionsConclusions

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

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

ConclusionsConclusions

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

The FutureThe Future

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

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

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

The FutureThe Future

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

85% of patients pad-free at 12 85% of patients pad-free at 12 months.months.

Median console time of 145 minutes.Median console time of 145 minutes.

The EndThe End

Any questions?Any questions?