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50 Vs 50

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.

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50 Vs 50

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  1. 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

  2. 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.

  3. Introduction • Beginning on 1st 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 cases.

  4. Methods • Patient Data: • Age • Pre-Operative PSA, Staging, Gleason Score • Pre-Operative Haemoglobin • Pre-Operative MRI Staging

  5. Methods • Measured Outcomes were: • Anaesthetic Time • Post-Operative Haemoglobin • Number of Nights in Hospital • Post-Operative Histopathology • Positive Margin Rate

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

  7. 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

  8. 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

  9. The Patient Groups • 50 consecutive patients in each group. Non-randomised, no matching. • Median Age • Retropubic : 62 • Robotic : 61 • Median PSA • Retropubic : 8.2 • Robotic : 7.1 • Percentage with MRI T3 Staging Pre-Op • Retropubic : 6% • Robotic : 8%

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

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

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

  13. Oncologic Outcomes • Stage >pT3 on Final Post-Op Histology • Retropubic : 32% • Robotic : 18% • Positive Margin Rate in pT2 Tumours • Retropubic : 24% • Robotic : 14%

  14. 12 Month Follow-Up • Biochemical Recurrence in First 12 months • Retropubic : 22% • Robotic : 4%

  15. 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.

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

  17. 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.

  18. 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.

  19. The End • Any questions?

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