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Does the presence of robotic surgery affect demographics in patients choosing to undergo radical prostatectomy? A multi-center contemporary analysis

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Abstract

We report on differences in patient demographics in those men choosing to undergo radical prostatectomy in a UK center where there is no influence of robotic surgery and in those choosing radical prostatectomy in a US center where there is a strong robotic influence. Demographic and pathologic data were prospectively recorded in parallel for 78 consecutive men undergoing robot-assisted radical prostatectomy in a tertiary care academic US center and 69 consecutive men concurrently undergoing open radical prostatectomy in a similar UK center. Although average patient age was significantly younger in the US cohort (58.8 years, range 43.1–77.6 vs. 62.2 years, range 51.7–70.5; P = 0.002), the US cohort encompassed a wider age range and older patients than the UK cohort. Average preoperative prostate-specific antigen (PSA) was significantly lower in the US group (6.0, range 2.0–6.0 vs. 8.60, range 4.6–12.6; P < 0.01). Biopsy Gleason score, clinical stage, final pathology Gleason score, pathologic staging and positive margin rate were not significantly different between the two groups. Blood loss and transfusion rate were significantly lower in the US group. 16.7% of men in the US cohort had overall positive surgical margins compared to 29% in the UK group (P = 0.07). This data confirms our belief that patient age ranges are different in a setting influenced by robotic surgery. Although pathologic parameters were similar, the age distribution of robotic surgery patients was much wider, suggesting robotics attracts men previously reluctant to undergo surgery in the open setting or to pursue active surveillance protocols. Larger studies are needed to verify this finding.

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References

  1. Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128:492–497

    CAS  PubMed  Google Scholar 

  2. Roehl KA, Han M, Ramos CG et al (2004) Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 172:910–914

    Article  PubMed  Google Scholar 

  3. Kundu SD, Roehl KA, Eggener SE et al (2004) Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 172:227–2231

    Article  Google Scholar 

  4. Han M, Partin AW, Pound CR et al (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy: the 15-year Johns Hopkins experience. Urol Clin North Am 28:555–565

    Article  CAS  PubMed  Google Scholar 

  5. Hull GW, Rabbani F, Abbas F et al (2002) Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 167:528–534

    Article  PubMed  Google Scholar 

  6. Kawachi MH (2007) Counterpoint: robot-assisted laparoscopic prostatectomy: perhaps the surgical gold standard for prostate cancer care. J Natl Compr Canc Netw 5(7):689–692

    PubMed  Google Scholar 

  7. Bentas W, Wolfram M, Jones J et al (2003) Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol 44(2):175–181

    Article  PubMed  Google Scholar 

  8. Menon M (2003) Robotic radical retropubic prostatectomy. BJU Int 91:175–176

    Article  CAS  PubMed  Google Scholar 

  9. Menon M, Tewari A, Baize B et al (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60(5):864–868

    Article  PubMed  Google Scholar 

  10. Bivalacqua TJ, Pierorazio PM, Su LM (2009) Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach. Surg Oncol 18(3):233–241

    Article  PubMed  Google Scholar 

  11. Parker WR, Montgomery JS, Wood DP Jr, Wood DP Jr (2009) Quality of life outcomes following treatment for localized prostate cancer: is there a clear winner? Curr Opin Urol 19(3):303–308

    Article  PubMed  Google Scholar 

  12. Miller J, Smith A, Kouba E et al (2007) Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy. J Urol 178:854–858

    Article  PubMed  Google Scholar 

  13. Dasgupta P, Kirby RS (2009) Outcomes of robotic assisted radical prostatectomy. Int J Urol 16(3):244–248

    Article  PubMed  Google Scholar 

  14. Smith JA Jr, Chan RC, Chang SS et al (2007) A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 178:2385–2389

    Article  PubMed  Google Scholar 

  15. Box GN, Ahlering TE (2008) Surgery in urology. Curr Opin Urol 18(2):173–179

    Article  PubMed  Google Scholar 

  16. Lotan Y, Cadeddu JA, Gettman MT (2004) The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol 172:1431–1435

    Article  PubMed  Google Scholar 

  17. Gallina A, Chun FK, Suardi N et al (2008) Comparison of stage migration patterns between Europe and the USA: an analysis of 11,350 men treated with radical prostatectomy for prostate cancer. BJUI 101(12):1513–1518

    Article  Google Scholar 

  18. Farkas A, Schneider D, Perrotti M et al (1998) National trends in the epidemiology of prostate cancer 1973–94: evidence for the effectiveness of prostate-specific antigen screening. Urology 52:444–448

    Article  CAS  PubMed  Google Scholar 

  19. Ryan CJ, Elkin EP, Small EJ et al (2006) Reduced incidence of bony metastasis at initial prostate cancer diagnosis data from CaPSURE. Urol Oncol 24:396–402

    PubMed  Google Scholar 

  20. Collin SM, Martin RM, Metcalfe C et al (2008) Prostate-cancer mortality in the USA and UK in 1975–2004: an ecological study. Lancet Onco 9(5):445–452

    Article  Google Scholar 

  21. Patel VR, Palmer KJ, Coughlin G et al (2008) Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol 22(10):2299–2305

    Article  PubMed  Google Scholar 

  22. Farnham S, Webster T, Herrell S et al (2006) Intraoperative blood loss and transfusion requirement for robotic assisted laparoscopic prostatectomy versus radical prostatectomy. Urology 67:360–363

    Article  PubMed  Google Scholar 

  23. Rocco B, Matei DV, Melegari S et al (2009) Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJUI 104(7):991–995

    Article  Google Scholar 

  24. Ahlering TE, Skarecky D, Lee D et al (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170(5):1738–1741

    Article  PubMed  Google Scholar 

  25. Patel VR, Tully AS, Holmes R et al (2005) Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases. J Urol 174(1):269–272

    Article  PubMed  Google Scholar 

  26. Smith JA Jr, Chan RC, Chang SS et al (2007) A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 178(6):2385–2389

    Article  PubMed  Google Scholar 

  27. Zorn KC, Orvieto MA, Gong EM et al (2007) Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol 21(4):441–447

    Article  PubMed  Google Scholar 

  28. Artibani W, Fracalanza S, Cavalleri S et al (2008) Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int 80(3):237–244

    Article  PubMed  Google Scholar 

  29. Menon M, Shrivastava A, Tewari A et al (2002) Laparoscopic and robot-assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168:945–949

    Article  PubMed  Google Scholar 

  30. Ahlering TE, Skarecky D, Lee D et al (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741

    Article  PubMed  Google Scholar 

  31. Zorn KC, Orvieto MA, Gong EM et al (2007) Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol 21(4):441–447

    Article  PubMed  Google Scholar 

  32. Magera JS Jr, Inman BA, Slezak JM et al (2008) Increased optical magnification from 2.5x to 4.3x with technical modification lowers the positive margin rate in open radical retropubic prostatectomy. J Urol 179(1):130–135

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Columbia Medical Center, New York, USA

    Philippa J. Cheetham, Daniel J. Lee & Ketan K. Badani

  2. Department of Urology, The Churchill Hospital, Oxford, UK

    Anna Rose-Morris & Simon F. Brewster

Authors
  1. Philippa J. Cheetham
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  2. Daniel J. Lee
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  3. Anna Rose-Morris
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  4. Simon F. Brewster
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  5. Ketan K. Badani
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Correspondence to Ketan K. Badani.

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Cheetham, P.J., Lee, D.J., Rose-Morris, A. et al. Does the presence of robotic surgery affect demographics in patients choosing to undergo radical prostatectomy? A multi-center contemporary analysis. J Robotic Surg 4, 155–160 (2010). https://doi.org/10.1007/s11701-010-0200-4

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  • DOI: https://doi.org/10.1007/s11701-010-0200-4

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