Yeungnam Univ J Med.  2018 Dec;35(2):171-178. 10.12701/yujm.2018.35.2.171.

Oncological and functional outcomes following robot-assisted laparoscopic radical prostatectomy at a single institution: a minimum 5-year follow-up

Affiliations
  • 1Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea. tgkwon@knu.ac.kr
  • 2Biomedical Research Institute, Kyungpook National University Hospital, Daegu, Korea.
  • 3Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract

BACKGROUND
To evaluate mid-term oncological and functional outcomes in patients with prostate cancer treated by robot-assisted laparoscopic radical prostatectomy (RALP) at our institution.
METHODS
We retrospectively reviewed the medical records of 128 patients with prostate cancer who underwent RALP at our institution between February 2008 and April 2010. All patients enrolled in this study were followed up for at least 5 years. We analyzed biochemical recurrence (BCR)-free survival using a Kaplan-Meier survival curve analysis and predictive factors for BCR using multivariate Cox regression analysis. Continence recovery rate, defined as no use of urinary pads, was also evaluated.
RESULTS
Based on the D'Amico risk classification, there were 30 low-risk patients (23.4%), 47 intermediate-risk patients (38.8%), and 51 high-risk patients (39.8%), preoperatively. Based on pathological findings, 50.0% of patients (64/128) showed non-organ confined disease (≥T3a) and 26.6% (34/128) had high grade disease (Gleason score ≥8). During a median follow-up period of 71 months (range, 66-78 months), the frequency of BCR was 33.6% (43/128) and the median BCR-free survival was 65.9 (0.4-88.0) months. Multivariate Cox regression analysis revealed that high grade disease (Gleason score ≥8) was an independent predictor for BCR (hazard ratio=4.180, 95% confidence interval=1.02-17.12, p=0.047). In addition, a majority of patients remained continent following the RALP procedure, without the need for additional intervention for post-prostatectomy incontinence.
CONCLUSION
Our study demonstrated acceptable outcomes following an initial RALP procedure, despite 50% of the patients investigated demonstrating high-risk features associated with non-organ confined disease.

Keyword

BCR; Prostate cancer; Prostatectomy; Urinary incontinence

MeSH Terms

Classification
Follow-Up Studies*
Humans
Medical Records
Prostatectomy*
Prostatic Neoplasms
Recurrence
Retrospective Studies
Urinary Incontinence

Figure

  • Fig. 1. Kaplan-Meier survival curve analysis of biochemical recurrence-free survival for all patients. BCR, biochemical recurrence; RALP, robot-assisted laparoscopic radical prostatectomy.

  • Fig. 2. Kaplan-Meier survival curve analysis of biochemical recurrence-free survival comparing the three D’Amico risk groups (A), patients based on pathological staging (B), Gleason score (C), and Lymphovascular invasion (D), using the log-rank test. RALP, robot-assisted laparoscopic radical prostatectomy.


Reference

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65:5–29.
Article
2. Han HH, Park JW, Na JC, Chung BH, Kim CS, Ko WJ. Epidemiology of prostate cancer in South Korea. Prostate Int. 2015; 3:99–102.
Article
3. Chopra S, Srivastava A, Tewari A. Robotic radical prostatectomy: the new gold standard. Arab J Urol. 2012; 10:23–31.
Article
4. D’Amico AV, Moul J, Carroll PR, Sun L, Lubeck D, Chen MH. Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol. 2003; 21:2163–72.
Article
5. Luciani LG, Mattevi D, Mantovani W, Cai T, Chiodini S, Vattovani V, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a comparative analysis of the surgical outcomes in a single regional center. Curr Urol. 2017; 11:36–41.
Article
6. Nossiter J, Sujenthiran A, Charman SC, Cathcart PJ, Aggarwal A, Payne H, et al. Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. Br J Cancer. 2018; 118:489–94.
Article
7. Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderäng U, Thorsteinsdottir T, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial. Eur Urol. 2015; 68:216–25.
Article
8. Kang YJ, Kim HS, Jang WS, Kwon JK, Yoon CY, Lee JY, et al. Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin. BMC Cancer. 2017; 17:321.
Article
9. Menon M, Bhandari M, Gupta N, Lane Z, Peabody JO, Rogers CG, et al. Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. Eur Urol. 2010; 58:838–46.
Article
10. Rajan P, Hagman A, Sooriakumaran P, Nyberg T, Wallerstedt A, Adding C, et al. Oncologic outcomes after robot-assisted radical prostatectomy: a large European single-centre cohort with median 10-year follow-up. Eur Urol Focus. 2018; 4:351–9.
Article
11. Sooriakumaran P, Haendler L, Nyberg T, Gronberg H, Nilsson A, Carlsson S, et al. Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum follow-up time of 5 years. Eur Urol. 2012; 62:768–74.
Article
12. Lee SH, Seo HJ, Lee NR, Son SK, Kim DK, Rha KH. Robot-assisted radical prostatectomy has lower biochemical recurrence than laparoscopic radical prostatectomy: systematic review and meta-analysis. Investig Clin Urol. 2017; 58:152–63.
Article
13. Abdel Raheem A, Kim DK, Santok GD, Alabdulaali I, Chung BH, Choi YD, et al. Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up. Int J Urol. 2016; 23:765–74.
Article
14. Diaz M, Peabody JO, Kapoor V, Sammon J, Rogers CG, Stricker H, et al. Oncologic outcomes at 10 years following robotic radical prostatectomy. Eur Urol. 2015; 67:1168–76.
Article
15. Shao IH, Chang YH, Hou CM, Lin ZF, Wu CT. Predictors of short-term and long-term incontinence after robot-assisted radical prostatectomy. J Int Med Res. 2018; 46:421–9.
Article
16. Kadono Y, Ueno S, Kadomoto S, Iwamoto H, Takezawa Y, Nakashima K, et al. Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: nerve-sparing technique contributes to the reduction of postprostatectomy incontinence. Neurourol Urodyn. 2016; 35:1034–9.
17. Honda M, Kawamoto B, Morizane S, Hikita K, Muraoka K, Sejima T, et al. A prognostic model for predicting urinary incontinence after robot-assisted radical prostatectomy. Int J Med Robot. 2017; 13:doi: 10.1002/rcs.1780.
Article
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