| |
Open Retropubic Radical Prostatectomy Versus Robot Assisted Radical Prostatectomy: A Prospective Comparison of Perioperative Data
Tait D. Fors, M.D.1, Timothy C. Siegrist2, Vincent P. Laudone, M.D.1, Cancer Z. Dinlenc, M.D.3, Joseph R. Wagner, M.D.1.
1Hartford Hospital, Hartford, CT, USA, 2John Dempsey Hospital, Farmington, CT, USA, 3Beth Israel Medical Center, New York, NY, USA.
Background: A prospective study of perioperative outcomes for open retropubic and robotic assisted radical prostatectomy.
Methods: A single institution, prospective, consecutive, non-randomized comparison of men choosing surgical treatment for localized prostate cancer from 1-1-04 to 12-31-04 was performed. All procedures were performed by a fellowship trained urologic oncologic surgeon. Patient age, PSA, Gleason score, clinical stage, and hematocrit were recorded. Patients were stratisfied into risk group categories per D'Amico et al (JAMA (280): 969-974, 1998). Low-risk (PSA <=10, and Gleason <7, and cT1 or cT2a), intermediate-risk (PSA 10.1-20, or Gleason 7, or cT2b/cT2c), or high-risk (PSA >20, or Gleason >=8, or cT3a/T3b). Surgical specimens were processed in standard fashion. Margins were considered positive if tumor was present at the inked margin; intraoperative biopsies were not considered. Discharge hematocrits and length of stay were recorded. P values < 0.10 are presented.
Results: 180 consecutive patients underwent surgery (68 open and 112 robotic). Preoperative variables between the two groups are summarized in table 1, pathologic outcomes in tables 2 and 3, and discharge data in table 4.
Conclusions: Robotic radical prostatectomy offers improved surgical margin rates, less blood loss, and shorter length of stay when compared to a similar open retropubic cohort.
Preoperative Variables| Variable | Open | Robotic | P-value | | Age | 60 (44-75) | 59 (45-70) | NS | | PSA | 7.0 (0.9-39.5) | 5.6 (0.3-21.5) | NS | | Gleason Score | 7.0 (0.9-39.5) | 5.6 (0.3-21.5) | NS | | Mean | 6.5 (6-8) | 6.3 (5-9) | NS | | 5 | 0 (0%) | 1 (0.9%) | NS | | 6 | 40 (58.8%) | 76 (67.9%) | NS | | 7 | 24 (35.3%) | 32 (28.6%) | NS | | 8 | 4 (5.9%) | 2 (1.8%) | NS | | 9 | 0 (0%) | 1 (0.9%) | NS |
Pathologic Outcomes| Variable | Open (68) | Robotic (112) | P-value | | Positive Margin | 26 (38.2%) | 28 (25.0%) | p=0.060 | | Low risk | 11/37 (29.8%) | 14/69 (20.3%) | NS | | Intermediate risk | 11/24 (45.8%) | 11/39 (28.2%) | NS | | High risk | 4/7 (57.1%) | 3/4 (75%) | NS | | >= pT3a | 14/18 (77.8%) | 12/18 (66.7%) | NS |
Pathologic outcomes| Variable | Open (68) | Robotic (112) | P-Value | | pT3a/pT3b | 18 (26.5%) | 18 (16.1%) | p = 0.091 | | Low risk | 6/37 (16.2%) | 8/39 (20.5%) | NS | | Intermediate risk | 7/24 (29.2%) | 8/39 (20.5%) | NS | | High risk | 5/7 (71.4%) | 2/4 (50.0%) | NS | | Gleason Score | 6.8 | 6.8 | NS | | Low risk | 6.6 (6-7) | 6.3 (5-7) | NS | | Intermediate risk | 7.0 (6-9) | 6.9 (6-8) | NS | | High risk | 7.3 (7-9) | 7.3 (7-8) | NS |
Discharge Data| Variable | Open (68) | Robotic (112) | P-Value | | Discharge Hct | 31.2 (22.3-37.0) | 34.9 (24.2-41.6) | p<0.001 | | Length of Stay (days) | 2.4 (1-5) | 1.7 (1-6) | p<0.001 | | # Discharged POD1 | 1 (1.5%) | 51 (45.5%) | p<0.001 |
Back to Final Program
|
|
