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

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

During this Transition period, a During this Transition period, a comparison of the two methods was comparison of the two methods was made.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 January 2007, the details of 50 consecutive Robotic details of 50 consecutive Robotic Assisted Laparoscopic Prostatectomy Assisted Laparoscopic Prostatectomy cases were entered into a database and cases were entered into a database and compared with the last 50 consecutive compared with the last 50 consecutive Radical Retropubic Prostatectomy cases.Radical Retropubic 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 Pre-Operative MRI StagingStaging

MethodsMethods

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

Number of Nights Number of Nights in Hospitalin Hospital

Post-Operative Post-Operative HistopathologyHistopathology

Positive Margin Positive Margin RateRate

MethodsMethods

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

Surgical TechniqueSurgical Technique

Radical Retropubic Radical Retropubic ProstatectomyProstatectomy 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 Planned In-Patient Stay of 7-10 days, TWOC prior to dischargedays, TWOC prior to discharge

Surgical TechniqueSurgical Technique

Robot Assisted Robot Assisted Laparoscopic Laparoscopic ProstatectomyProstatectomy 6 ports6 ports Robinson’s drain for Robinson’s drain for 12-24 hours12-24 hours

Planned In-Patient Planned In-Patient Stay of 1-2 daysStay of 1-2 days

TWOC as Out-Patient TWOC as Out-Patient at 10 daysat 10 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 50 consecutive patients in each group. Non-randomised, no matching.matching.

The SurgeryThe Surgery Median Time Under Median Time Under AnaesthesiaAnaesthesia RetropubicRetropubic : 95 mins: 95 mins RoboticRobotic : 270 : 270 minsmins

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

Median Number of Post-Median Number of Post-Op Nights in HospitalOp Nights 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

open robotic0

5

10

15Mean ± SEM

p < 0.0001

Hospital Stay (nights)

Operative Group

( )Mean of Hospital Stay nights

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

open robotic0

1

2

3

4

5Mean ± SEM

p < 0.0002

Hb Drop (gm/100mL)

Operative Group

( /100 )Hb Drop gm mL

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 Recurrence in First 12 monthsFirst 12 months RetropubicRetropubic : : 22%22%

RoboticRobotic : : 4%4%

ConclusionsConclusions

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

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

ConclusionsConclusions

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

The FutureThe Future

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

The data shows a consistent The data shows a consistent Positive Margin Rate of 14.7%.Positive 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 Median console time of 145 minutes.minutes.

The EndThe End

Any questions?Any questions?