scholarly journals Robotic radical prostatectomy: difficult to start, fast to improve? Influence of surgical experience in robotic and open radical prostatectomy

2021 ◽  
Author(s):  
Martin Baunacke ◽  
Awab Azawia ◽  
Johannes Huber ◽  
Christer Groeben ◽  
Christian Thomas ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Operating Time ◽  
Learning Curves ◽  
Surgical Experience ◽  
Surgical Performance ◽  
Lymph Node Yield ◽  
Open Radical Prostatectomy ◽  
Node Yield

Abstract Purpose The assistance of robotic systems raises the concern of whether there is an improved learning in robotic-assisted radical prostatectomy (RARP) compared to open retropubic radical prostatectomy (ORP). Methods We retrospectively analyzed data from 1438 patients who underwent ORP (n = 735) or RARP (n = 703). For each procedure, the level of experience of three different surgeons was summarized. Perioperative and pathological parameters reflecting surgical performance were compared between both learning curves. RARP data were influenced by new introduction of the robotic system. Results The median patient age at surgery was 66 years (IQR 42–80). Patients in the RARP group were younger (p < 0.001) and had a lower oncological risk (p < 0.001). Inexperienced RARP surgeons had a higher pT2-PSM rate and lower lymph node yield (13.8 ± 4.7 vs. 14.7 ± 4.8; p = 0.03) than inexperienced ORP surgeons. After 100 procedures, RARP and ORP surgeons had the same pT2-PSM rate (8% vs. 8%; p = 0.8) and lymph node yield (15.4 ± 5.4 vs. 15.4 ± 5.1; p = 1.0). In multivariate analysis for ORP, surgical inexperience (≤ 100 cases) was an independent predictor of a longer operating time (OR 9.0; p < 0.001) and higher amount of blood loss (OR 2.9; p < 0.001). For RARP, surgical inexperience (≤ 100 cases) was a predictor of a longer operating time (OR 3.9; p < 0.001), higher amount of blood loss (OR 1.9; p = 0.004), higher pT2-PSM rate (OR 1.6; p = 0.03), and lower lymph node yield (OR 0.6; p = 0.001). Conclusions Surgical experience has a relevant impact on perioperative and pathological parameters RARP has a higher initial pT2-PSM rate and lower lymph node yield than ORP. This is relevant for patient selection for novice teaching in RARP.

Pathological analysis of lymph nodes in anterior prostatic fat excised at robot-assisted radical prostatectomy

2014 ◽  
Vol 67 (9) ◽  
pp. 787-791 ◽  
Author(s):  
J J Aning ◽  
R Thurairaja ◽  
D A Gillatt ◽  
A J Koupparis ◽  
E W Rowe ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Robot Assisted ◽  
Lymph Node Yield ◽  
Extended Lymph Node Dissection ◽  
Pathological Analysis ◽  
Node Yield

AimsTo assess the lymph node content of anterior prostatic fat (APF) sent routinely at robot-assisted laparoscopic radical prostatectomy (RALP) and the incidence of positive nodes in the extended pelvic lymph node dissection.MethodsBetween September 2008 and April 2012, APF excised from 282 patients who underwent RALP was sent for pathological analysis. This tissue was completely embedded and lymph nodes counted.ResultsIn total, 49/282 (17%) patients had lymph nodes in the APF, median lymph node yield in this tissue was 1 (range 1–5). In four patients, the lymph nodes contained metastatic deposits. These patients did not have positive nodes elsewhere in the extended lymph node dissection.ConclusionsAPF contains lymph nodes in 1 in 6 patients and infrequently these may be malignant. APF should always be removed at radical prostatectomy. APF should be routinely sent for pathological analysis.

Clinical risk-based associations of lymph node dissection and detection of metastasis among men treated with radical prostatectomy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 284-284
Author(s):  
Alejandro Abello ◽  
Patrick Aloysius Kenney ◽  
Michael Leapman
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Node Metastasis ◽  
Node Dissection ◽  
Risk Status ◽  
Lymph Node Yield ◽  
Lymph Node Count ◽  
Node Metastasis ◽  
Node Count ◽  
Node Yield

284 Background: Pelvic lymph node dissection (PLND) is recommended for most men at risk for lymph node involvement at the time of radical prostatectomy (RP) yet is frequently omitted. We aimed to examine the probability of PLND based on clinical risk status, and evaluate the impact of increasing lymph node yield on cancer detection rate across risk strata. Methods: We queried the National Cancer Database from 2004 to 2014 to identify patients with clinically localized PCa who underwent RP as their primary treatment. We extracted patient clinical and sociodemographic variables. Risk status was assessed using UCSF Cancer of the Prostate Risk Assessment (CAPRA) score. We fit conditional logistic regression models to estimate likelihood of PLND and incremental value of increasing lymph node count by risk strata. Results: We identified 698,728 men with PCa treated with RP including 380.201 (54.41%) whit PLND. Mean age at diagnosis was 62.6. PLND was omitted (Nx) in 56.1% of patients with low CAPRA-risk disease, 31.44% with intermediate and 24.72% high. Proportion of patients with >30 lymph nodes removed decreased from 9.3% on 2004 to 3.64% on 2014. Adjusting for clinical and pathologic factors, treatment in a community versus academic (Odds Ratio, OR=1.62, 95% CI 1.59-1.66; P <0.001) and black race (OR=1.13, 95% CI 1.09-1.17, P: 0.01) was associated with pNx status. Increasing lymph node count was independently associated with greater likelihood of detection of lymph node metastasis in all risk strata (11-20 nodes: OR: 3.13 , 95% CI 2.90-3.37, P<0.001; 20-30 nodes: OR: 5.07 , 95% CI 4.50-5.73, P<0.001; >30 nodes OR: 6.58, 95% CI 5.38-8.05, P<0.001) including patients with CAPRA-0 (11-20 nodes: OR: 3.28 , 95% CI 3.06-3.53, P<0.001; 20-30 nodes: OR: 5.77, 95% CI 5.16-6.45, P<0.001; >30 nodes OR: 7.90, 95% CI 6.56-9.51, P<0.001). Conclusions: PLND continues to be omitted in a substantial proportion of intermediate and high risk patients. Increasing lymph node yield was associated with greater odds of detecting lymph node metastasis in all groups of patients, including those at the lowest level of risk by clinical criteria.

A comprehensive assessment of postoperative complications in female patients undergoing robot versus open radical cystectomy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 490-490
Author(s):  
Vikram M Narayan ◽  
Mohamed Seif ◽  
Amy Lim ◽  
Roger Li ◽  
Wei Qiao ◽  
...  
Keyword(s):  
Lymph Node ◽  
Blood Loss ◽  
Radical Cystectomy ◽  
Smoking History ◽  
Cancer Center ◽  
Wound Complications ◽  
Robotic Approach ◽  
Lymph Node Yield ◽  
Female Patients ◽  
Node Yield

490 Background: Radical cystectomy (RC) is the standard of care for non-metastatic, muscle invasive bladder cancer. Studies comparing robotic to open RC have found that the robotic approach confers non-inferior oncologic outcomes while potentially decreasing morbidity, but to date there have been no comparisons performed exclusively within female patients, who have unique anatomic considerations. Women undergoing RC may be at higher risk for urethral margin positivity, wound complications, and bleeding. Methods: Female patients who underwent either open or robot-assisted RC at the MD Anderson Cancer Center from 1/2014-6/2018 were identified. We assessed co-morbidities, pathologic data, and outcomes including complications. Descriptive statistics, along with uni- and multivariable logistic regression, were performed. Results: 122 female patients underwent either open (n=76) or robotic (n=46) RC. There were no statistically significant differences in age, BMI, smoking history, exposure to neoadjuvant chemotherapy, Charlson comorbidity index, or cTNM stages between the groups. In both uni- and multivariable models, open RC in females was associated with greater blood loss (median EBL 775 mL, IQR 600 mL) compared with robotic RC (median EBL 300 mL, IQR 350 mL), p<0.001. Female open RC was also associated with greater risk of transfusion compared to robotic RC (OR 6.2, 95% CI 2.7-14.3, p<0.001). Robotic RC conferred a higher median lymph node yield (27 nodes (range 7,57) vs 20 nodes (0,57), p, <0.001). Operative times were longer in the robotic cohort (median 507 min vs 388 min, p<0.001). There were no differences between robotic vs open groups in margin positivity (5.3% vs 4.4%, p≥0.99), length of stay (6.3 vs 6.9 days, p=0.32), or readmission rates at 30 (26.1% vs 22.7%, p=0.67) and 90 days (32.6% vs 28%, p=0.68). Conclusions: In this cohort of women undergoing RC, the robotic approach was associated with a lower risk of transfusion and EBL, and a higher median lymph node yield and operative time. Unique anatomic considerations in female patients and the improved visualization conferred by the robotic approach may be responsible for these findings, particularly with respect to blood loss.

1949 LYMPH NODE YIELD USING THE STANDARD LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY

2010 ◽  
Vol 183 (4S) ◽  
Author(s):  
Guilherme Godoy ◽  
Christian von Bodman ◽  
Daher Chade ◽  
Kinjal Vora ◽  
Ozdal Dillioglugil ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Lymph Node Yield ◽  
Node Yield

Total submission of pelvic lymphadenectomy tissues removed during radical prostatectomy for prostate cancer increases lymph node yield and detection of micrometastases

2013 ◽  
Vol 64 (3) ◽  
pp. 399-404 ◽  
Author(s):  
Joanna Perry-Keene ◽  
Peter Ferguson ◽  
Hemamali Samaratunga ◽  
John N Nacey ◽  
Brett Delahunt
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Pelvic Lymphadenectomy ◽  
Lymph Node Yield ◽  
Node Yield

scholarly journals Defining benchmarks for robotic-assisted low anterior rectum resection in low-morbid patients: a multicenter analysis

2021 ◽  
Author(s):  
Jan-Hendrik Egberts ◽  
Jan-Niclas Kersebaum ◽  
Benno Mann ◽  
Heiko Aselmann ◽  
Markus Hirschburger ◽  
...  
Keyword(s):  
Lymph Node ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Surgical Performance ◽  
Intraoperative Complication ◽  
Lymph Node Yield ◽  
Robotic Assisted ◽  
Extended Surgery ◽  
Rectum Resection ◽  
Node Yield

Abstract Purpose To define the best possible outcomes for robotic-assisted low anterior rectum resection (RLAR) using total mesorectal excision (TME) in low-morbid patients, performed by expert robotic surgeons in German robotic centers. The benchmark values were derived from these results. Methods The data was retrospectively collected from five German expert centers. After patient exclusion (prior surgery, extended surgery, no prior anastomosis, hand-sewn anastomosis), the benchmark cohort was defined (n = 226). The median with interquartile range was first calculated for the individual centers. The 75th percentile of the median results was defined as the benchmark cutoff and represents the “perfect” achievable outcome. This applied to all benchmark values apart from lymph node yield, where the cutoff was defined as the 25th percentile (more lymph nodes are better). Results The benchmark values for conversion and intraoperative complication rates were ≤ 4.0% and ≤ 1.4%, respectively. For postoperative complications, the benchmark was ≤ 28% for “any” and ≤ 18.0% for major complications. The R0 and complete TME rate benchmarks were both 100%, with a lymph node yield of > 18. The benchmark for rate of anastomotic insufficiency was < 12.5% and 90-day mortality was 0%. Readmission rates should not exceed 4%. Conclusion This outcome analysis of patients with low comorbidity undergoing RLAR may serve as a reference to evaluate surgical performance in robotic rectum resection.

scholarly journals Artery first versus traditional approach in pancreatoduodenectomy for pancreatic head cancer

2020 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Ali Zedan Tohamy ◽  
Hanan A. Eltyb ◽  
Marwa T. Hussien ◽  
Haisam Atta
Keyword(s):  
Lymph Node ◽  
Length Of Stay ◽  
Blood Loss ◽  
Operative Time ◽  
R0 Resection ◽  
Complication Rates ◽  
Term Survival ◽  
Lymph Node Yield ◽  
Artery First ◽  
Node Yield

Background: Artery first approach pancreatoduodenectomy (AFAPD) technique is one of the many modifications of the standard whipple procedure (sPD) thus enabling a complete dissection of the right side of this artery and of the portal vein, as well as a complete excision of the retroportal pancreatic lamina. Objective was to evaluate the clinical, perioperative and oncological outcomes of “artery first” approach compared with those of the traditional approach.Methods: Between 2010 and 2019, The present study includes two groups of patients. A first group of 28 patients with PD by “artery first” and a second group including 28 matched patients with PD by TAPD. Demographic characteristics (sex, age), intraoperative data (approach type, operative time, blood loss, intraoperative complications, need for vascular resections), histological diagnosis and pathology data (tumor location, TNM staging, tumor grading, tumor vascular invasion) and patient outcomes (postoperative length of stay, in-hospital postoperative mortality and morbidity, survival time) were collected.Results: There were no significant differences between the two groups regarding: total operative time (422 vs. 460.min, p=0.19), estimated blood loss (p=0.67), median length of stay (14 days in both groups) (p=0. 0.39), complication rates (32.1% and 35.7%) (p=0. 1.00), lymph node yield (22 and 21) and R0 resection rate (75% and 67.9%).  Conclusions: We concluded that artery first” offers similar operative time, intraoperative blood loss, R0 resection rates, lymph node yield and long-term survival as TAPD.

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