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TheScientificWorldJOURNAL (ISSN 1537-744X) |
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Title: |
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Histopathologic Outcomes of Robotic Radical Prostatectomy |
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Authors: |
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Patel, Vipul R.; Shah, Sagar ; Arend, David |
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Journal: |
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TheScientificWorldJOURNAL |
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Year: |
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2006 |
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Volume: |
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6 |
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Page Range: |
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2566-2572 |
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Article Type: |
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Research Article |
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Handling Editor: |
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William D. Steers |
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Domains: |
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Urology
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Surgery
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DOI: |
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10.1100/tsw.2006.397 |
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Synopsis: |
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Robotic radical prostatectomy is a revolutionary innovation in the treatment of prostate cancer. What was once a potentially morbid surgical option has now been transformed into a minimally invasive approach. Our study demonstrates the excellent cancer outcomes that are possible utilizing the robotic approach. |
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Keywords: |
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prostatectomy, prostate cancer, robotic, laparoscopic |
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Abstract |
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Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and short-term PSA outcomes of 500 robotic radical prostatectomies.
Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM stage, Gleason’s grade, tumor location, volume, specimen weight, seminal vesicle involvement, and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data were collected every 3 months for the first year, then every 6 months for a year, then yearly.
The average preoperative PSA was 6.9 (1–90) with Gleason’s score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), and 9 (2%); postoperatively, histopathologic analysis showed Gleason’s 6 (44%), 7 (42%), 8 (10%), and 9 (4%); 10, 5, 63, 15, 5, and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b, and T4, respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1–100), 8% (101–200), 13% (201–300), 5% (301–400), and 8% (401–500). By stage, it was 2, 4, and 2.5% for T2a, T2b, T2c tumors; 23% (T3a), 46% (T3b), and 53% (T4a). For organ-confined disease (T2), the margin rate was 2.5% and it was 31% for nonorgan-confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle, and 11 (23%) multifocal. Ninety-five percent of patients (n = 500) have undetectable PSA (<0.1) at average follow-up of 9.7 months. Recurrence has only been seen with nonorgan-confined tumors. Of those patients with a minimum follow-up of 1 year (average 15.7 months), 95% have undetectable PSA (<0.1).
Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall, positive margin rate. Short-term biochemical recurrence-free survival has also been good. We believe that the precise dissection allowed by the advantages of laparoscopic robotic surgery will translate into excellent long-term oncologic outcomes. At this time, the lack of maturity of the PSA data prevent definitive comparison to the open approach.
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