Robot-Assisted Radical Prostatectomy in Hong Kong: A Review of 235 Cases

Abstract

Objectives:

To report the outcome of all robot-assisted laparoscopic radical prostatectomy (RALP) in the public health care system in Hong Kong.

Patients and Methods:

All patients who underwent RALP in the public health care system with at least 1 year of follow-up were evaluated. Data analysis included age, body mass index, preoperative prostate-specific antigen (PSA) level, D'Amico risk category, operative details, pathologic stage, follow-up continence, potency, and biochemical recurrence.

Results:

Between 2005 and 2009, 235 patients underwent RALP, with a mean age of 66.4±5.9 years and a mean preoperative PSA level of 11.0±10.5 ng/mL. Complications were 16 (7%) in total. There were 176 (74.9%) patients with pT₂ disease and 55 (23.4%) patients with pT₃ disease. The overall rate of positive surgical margins (PSM) was 20.7%. At postoperative 12 months, 72.5% of the patients were pad free. For those 83 preoperative potent patients having nerve-sparing surgery, the overall trifecta rate at 12 months was 37.3%. Multivariate analysis identified that pathologic T staging was significantly associated with PSM, with an odds ratio (OR) of 7.884 (95% confidence interval [CI]: 3.576–17.379; P<0.001) for the pT₃ group compared with the pT₂ group. When comparing D'Amico medium- and high-risk categories with low-risk categories, they were found to be significantly associated with biochemical failure (medium- compared with low-risk: OR=3.536, 95% CI: 1.253–10.173, P=0.016; high- compared with low-risk: OR=10.214, 95% CI: 2.958–35.274, P<0.001).

Conclusions:

Our data demonstrate the feasibility, safety, and efficacy of RALP in low-to-intermediate volume centers. Our early oncologic outcomes were significantly correlated with pathologic stage and D'Amico risk stratification.

Get full access to this article

View all access options for this article.

References

Ferlay

, Shin

, Bray

et al.

GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]

Lyon, France: International Agency for Research on Cancer, 2010. http://globocan.iarc.fr. 2011 December 6.

Yip

SKh

, Sim

. Robotic radical prostatectomy in east Asia: development, surgical results and challenges. Curr Opin Urol, 2010; 20:80–85.

Hong Kong Hospital Authority. Hong Kong Cancer Registry. 2011 February .

Bill-Axelson

, Holmberg

, Ruutu

et al. Scandinavian Prostate Cancer Group Study No. 4. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med, 2005; 352:1977–1984.

Schuessler

, Schulam

, Clayman

, Kavoussi

. Laparoscopic radical prostatectomy: Initial short-term experience. Urology, 1997; 50:854–857.

, Yang

, Wang

et al. Robotic-assisted laparoscopic radical prostatectomy: Cearning curve of first 100 cases. Int J Urol, 2010; 17:635–640.

Sundram

. Asian robotic experience. Urol Oncol, 2010; 28:677–681.

Sung

, Jeong

, Park

et al. The “halo effect” in Korea: Change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy. J Robotic Surg, 2009; 3:57–60.

, Ng

, Lam

et al. Short-term outcome of patients with robot-assisted versus open radical prostatectomy for localised carcinoma of prostate. Hong Kong Med J, 2010; 16:31–35.

10.

Van Velthoven

, Ahlering

, Peltier

et al. Technique for laparoscopic running urethrovesical anastomosis: The single knot method. Urology, 2003; 61:699–702.

11.

D'Amico

, Whittington

, Malkowicz

et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA, 1998; 280:969–974.

12.

Binder

, Kramer

. Robotically-assisted laparoscopic radical prostatectomy. BJU Int, 2001; 87:408–410.

13.

Lotan

, Bolenz

, Gupta

et al. The effect of the approach to radical prostatectomy on the profitability of hospitals and surgeons. BJU Int, 2010; 105:1531–1535.

14.

Han

, Partin

, Pound

et al. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am, 2001; 28:555–565.

15.

Badani

, Kaul

, Menon

. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer, 2007; 110:1951–1958.

16.

Patel

, Palmer

, Coughlin

, Samavedi

. Robot-assisted laparoscopic radical prostatectomy: Perioperative outcomes of 1500 cases. J Endourol, 2008; 22:2299–2305.

17.

Coelho

, Chauhan

, Palmer

et al. Robotic-assisted radical prostatectomy: A review of current outcomes. BJU Int, 2009; 104:1428–1435.

18.

Boccon-Gibod

, Bertaccini

, Bono

et al. Management of locally advanced prostate cancer: A European consensus. Int J Clin Pract, 2003; 57:187–194.

19.

Weizer

, Strope

, Wood

Jr.

Margin control in robotic and laparoscopic prostatectomy: Ahat are the REAL outcomes?

Urol Oncol, 2010; 28:210–214.

20.

Ham

, Park

, Rha

et al. Robotic radical prostatectomy for patients with locally advanced prostate cancer is feasible: Results of a single-institution study. J Laparoendosc Adv Surg Tech A, 2009; 19:329–332.

21.

Ficarra

, Cavalleri

, Novara

et al. Evidence from robot-assisted laparoscopic radical prostatectomy: A systematic review. Eur Urol, 2007; 51:45–56.

22.

Mulhall

, Parker

, Waters

, Flanigan

. The timing of penile rehabilitation after bilateral nerve-sparing radical prostatectomy affects the recovery of erectile function. BJU Int, 2010; 105:37–41.

23.

Rogers

, Su

, Link

et al. Age stratified functional outcomes after laparoscopic radical prostatectomy. J Urol, 2006; 176:2448–2452.

24.

Secin

, Jiborn

, Bjartell

et al. Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol, 2008; 53:134–145.

25.

Yee

, Chung

, Ip

et al. Incidence of thromboembolism after robotic-assisted laparoscopic radical prostatectomy. J Endourol, 2008; 22:A40.

26.

Salomon

, Saint

, Anastasiadis

et al. Combined reporting of cancer control and functional results of radical prostatectomy. Eur Urol, 2003; 44:656–660.

27.

Shikanov

, Zorn

, Zagaja

, Shalhav

. Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology, 2009; 74:619–623.

28.

Patel

, Coelho

, Chauhan

et al. Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: Early trifecta results of a high-volume surgeon. BJU Int, 2010; 106:696–702.

29.

Ahlering

, Skarecky

, Lee

, Clayman

. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: Initial experience with laparoscopic radical prostatectomy. J Urol, 2003; 170:1738–1741.

30.

Murphy

, Challacombe

, Costello

. Outcomes after robot-assisted laparoscopic radical prostatectomy. Asian J Androl, 2009; 11:94–99.

31.

Denberg

, Flanigan

, Kim

et al. Self-reported volume of radical prostatectomies among urologists in the USA. BJU Int, 2007; 99:339–343.

32.

Barbash

, Glied

. New technology and health care costs—the case of robot-assisted surgery. N Engl J Med, 2010; 363:701–704.