Robotic Radical Prostatectomy at the Egyptian National Cancer Institute: Overcoming the Challenges in the Initial Case Series

BACKGROUND: Robotic prostatectomy is showing progressive worldwide spread owing to potential clinical benefits, but at a higher cost. AIM: This article describes the challenges and clinical outcomes of the first group of patients undergoing robotic prostatectomy in Egypt. DESIGN, SETTING, PARTICIPANTS: From 2017 to 2019, the data of all (55) patients undergoing robotic radical prostatectomy at the National Cancer Institute of Egypt were retrospectively analyzed. OUTCOME EVALUATION: Short-term operative outcomes, complications, technical difficulties, pathologic data, and biochemical recurrence were reported. RESULTS: Average blood loss was 296 ml; one patient required blood transfusion. One case required open conversion, another required re-docking of the robot. Setup time was significantly improved from an average of 27.7 min in the first 27 cases to an average of 17.3 min in the final 28 cases (p < 0.0001). Complications developed in 27% of our patients. Continence recovery at catheter removal, 1st, 3rd, 6th, and 12th months were 32.7%, 50.9%, 65.5%, 74.5%, and 96%, respectively. CONCLUSIONS: Results from the first series of robotic radical prostatectomy were encouraging. Technical challenges can be overcome in a short period using a dedicated team supplemented by institutional support. Acceptable complication rate and satisfactory outcomes regarding continence and blood loss were observed.

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Robotic Radical Prostatectomy at the Egyptian National Cancer Institute: Overcoming the Challenges in the Initial Case Series

10.21203/rs.3.rs-243859/v1 ◽

2021 ◽

Author(s):

Ashraf Saad Zaghloul ◽

Ahmed Abdelbary ◽

Amr Fergany ◽

Hatem Aboulkassem ◽

Waleed Mohamed Fadlalla

Keyword(s):

Radical Prostatectomy ◽

Blood Loss ◽

National Cancer Institute ◽

Case Series ◽

Setup Time ◽

Robotic Prostatectomy ◽

Outcome Evaluation ◽

Robotic Radical Prostatectomy ◽

Open Conversion ◽

Short Period

Abstract Background Robotic prostatectomy is showing progressive worldwide spread owing to potential clinical benefits, but at a higher cost. Objective This article describes the challenges and clinical outcome of the first group of patients undergoing robotic prostatectomy in Egypt. Design, setting, participants From 2017 to 2019, the data of all (55) patients undergoing robotic radical prostatectomy at the National Cancer Institute of Egypt was analyzed. Outcome evaluation Short term operative outcomes, complications, technical difficulties, pathologic data and biochemical recurrence were reported. Results Average blood loss was 296 ml; one patient required blood transfusion. One case required open conversion, another required re-docking of the robot. Setup time was significantly improved from an average of 27.7 minutes in the first 27 cases to an average of 17.3 minutes in the final 28 cases (p < 0.0001). Complications developed in 27% of our patients. Continence recovery at catheter removal, first, third, sixth and twelfth months were 32.7%, 50.9%, 65.5%, 74.5%, and 96%, respectively. Conclusions Results from the first series of robotic radical prostatectomy were encouraging. Technical challenges can be overcome in a short period. Acceptable complication rate and satisfactory outcomes regarding continence and blood loss were observed.

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Single plus one port robotic radical prostatectomy (SPORP); Initial experience

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.3.178 ◽

2017 ◽

Vol 89 (3) ◽

pp. 178 ◽

Cited By ~ 4

Author(s):

Volkan Tugcu ◽

Abdulmuttalip Simsek ◽

Ismail Evren ◽

Kamil Gokhan Seker ◽

Ramazan Kocakaya ◽

...

Keyword(s):

Prostate Cancer ◽

Postoperative Complications ◽

Radical Prostatectomy ◽

Serum Level ◽

Blood Loss ◽

Clinical Stage ◽

Operating Time ◽

Positive Surgical Margin ◽

Robotic Radical Prostatectomy ◽

Postoperative Continence

Objective: This article reports on patients with early stage prostate cancer treated with single plus one port robotic radical prostatectomy (SPORP). Materials and methods: Since January 2014, we performed SPORP in 8 patients with localized prostate cancer. Age of patients, clinical stage, operation time, intraoperative and postoperative complications, blood loss, histopathological evaluation, postoperative continence, serum level of PSA were evaluated. Results: Mean age of the 8 patients was 59.85 years. All operations were completed without conversion to standard robotic procedure or open surgery. No intra operative complications occurred. Mean operating time was 143 minutes; prostate excision 123 minutes and urethrovesical anastomosis 20 minutes. Mean blood loss was 45 ml. Preoperative Gleason scores were (3 + 4) in one patient and (3 + 3) in 7 patients. Postoperative Gleason scores were (3 + 4) in 2 patients, and (3 + 3) in 6 patients. All these 8 cases were in T1c clinical stage. Early postoperative complications were drain leakage (n = 1), atelectasis (n = 1), wound infection (n = 1) and fever (n = 1). There was no positive surgical margin. The serum level of PSA was less than 0.2 ng/ml and no other complications happened during the 4 to 12 months follow-up period. Postoperative continence and cosmetic results were excellent. Conclusions: It is relatively easy for urologists who are skilled in traditional laparoscopic and robotic surgeries to master SPORP. However long-term outcomes of this surgery need further investigations.

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Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the peri-surgical/oncological outcomes with younger patients.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.134 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 134-134

Author(s):

Takehiro Iwata ◽

Takashi Saika ◽

Kohei Edamura

Keyword(s):

Comparative Analysis ◽

Radical Prostatectomy ◽

Blood Loss ◽

Elderly Patients ◽

Robot Assisted ◽

Younger Patients ◽

Open Conversion ◽

Oncological Outcomes ◽

Elder Patients ◽

Estimated Blood Loss

134 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical/oncological outcomes for younger and elderly patients underwent RARP. Methods: We reviewed and compared our initial 340 consecutive patients who underwent RARP from 9/2012 to 8/2015 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 70 and over 70 years. Results: In our cohort, 202 men were age less than 70 and 138 men were ≥70. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and elder groups. Operative time (median: 167 vs. 171 minutes) and estimated blood loss were similar in both groups. One of elder patients (0.7%) needed transfusion. Peri/post-operative complications in both groups appeared to be minimal with no cases of intra-operative open conversion. One of younger patients needed a surgical settlement for port site herniation. Surgical positive margin rates in organ-confined (pT2) disease were also similar (5.6%, younger vs. 9.0%,elder). Continence at 3 months was 82% in elder patients as opposed to 87% in younger patients. Median follow-up period in in elder patients and younger patients were 15.2 and 15.3 months, respectively. Biochemical recurrence free survival rates in elder patients and younger patients were 89.9% and 93.6%, respectively (p=0.1026). Conclusions: In our study, RARP in elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.

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Feasibility of robot-assisted radical prostatectomy in high elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.120 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 120-120 ◽

Cited By ~ 1

Author(s):

Noriyoshi Miura ◽

Terutaka Noda ◽

Kenichi Nishimura ◽

Tetsuya Fukumoto ◽

Yutaka Yanagihara ◽

...

Keyword(s):

Comparative Analysis ◽

Radical Prostatectomy ◽

Blood Loss ◽

Elderly Patients ◽

Robot Assisted ◽

Younger Patients ◽

Open Conversion ◽

Oncological Outcomes ◽

Elder Patients ◽

Estimated Blood Loss

120 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 553 consecutive patients who underwent RARP in 3 institutes from 6/2013 to 2/2018 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 477 men were age less than 75 and 76 men were ≥75. Preoperative parameters (PSA, T factor) were similar in both younger and high elder groups. But Gleason score was higher in elder group than younger group ( p=0.009). Operative time (median: 232 vs. 212 minutes) and estimated blood loss (median 100 ml vs 100 ml) were similar in both groups. Two of elder patients (3.8%) needed transfusion. Peri/post-operative all grade complications were 1.4%/6.5% in younger group and 3.8%/9.6% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates were also similar (29.5%, younger vs. 23.7%, elder). Both younger patients (93.6%) and elder patients (90.3%) recovered their continence at 12 months. After a median follow-up of 33.0 months, the 3-year PSA-free survival rates were 86.0% for elder patients and 88.9% for younger patients (p>0.05). Conclusions: In our study, RARP in high elderly patients was relatively safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes. RARP is feasible even in elderly patients.

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Robotic Radical Prostatectomy in Patients with Previous Prostate Surgery and Radiotherapy

Prostate Cancer ◽

10.1155/2014/367675 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Ömer Acar ◽

Tarık Esen

Keyword(s):

Radical Prostatectomy ◽

Case Series ◽

Oncologic Outcome ◽

Functional Results ◽

Current Data ◽

Patient Counseling ◽

Robot Assisted ◽

Robotic Radical Prostatectomy ◽

Number Of Patients

Herein, we will review the available literature about robot-assisted radical prostatectomy in patients who have undergone prostate surgery or radiotherapy. Current data about this topic consists of small case series with limited follow-up. Despite being technically demanding, robot-assisted radical prostatectomy (RARP) can be considered feasible in either setting. Prostate surgery or prostatic irradiation should not be considered as a contraindication for robot-assisted radical prostatectomy. Nevertheless, patient counseling about the possible complications and the need for reintervention is of extreme importance in this patient population. Early oncologic and functional results of RARP performed in case of radiorecurrent prostate cancer look promising. Regarding postprostate surgery RARP, some series have reported comparable results, while some have demonstrated more inferior outcomes than those of naive cases. In order to assess the exact functional and oncologic outcome of RARP in patients with previous prostate surgery and radiotherapy, studies enrolling higher number of patients and providing longer follow-up data are needed.

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The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

Siberian Journal of Oncology ◽

10.21294/1814-4861-2021-20-6-32-40 ◽

2022 ◽

Vol 20 (6) ◽

pp. 32-40

Author(s):

A. V. Zyryanov ◽

A. S. Surikov ◽

A. A. Keln ◽

A. V. Ponomarev ◽

V. G. Sobenin

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Blood Loss ◽

Comparison Group ◽

Prostate Volume ◽

Robotic Prostatectomy ◽

Study Group ◽

Open Prostatectomy ◽

Large Prostate ◽

Blood Loss Volume

Background. The increased volume of the prostate in patients with confirmed prostate cancer (pc) is observed in 10 % of cases. The limitations of external beam radiotherapy and brachytherapy associated with large prostate volume and obstructive symptoms define radical prostatectomy (Rp) as the only possible treatment for prostate cancer in these patients. The purpose of the study was to determine the importance of the surgical approach in radical prostatectomy in patients with abnormal anatomy of the prostate. Material and methods. The study group consisted of patients with a prostate volume of more than 80 cm3 (n=40) who underwent a robot prostatectomy. The comparison group was represented by patients also selected by the prostate volume ≥ 80 cm3, who underwent classical open prostatectomy (n=44). The groups were comparable in age and psa level. The average prostate volume in the study group was 112.2 ± 26 cm 3(80–195 cm 3). The average prostate volume in the comparison group was 109.8 ± 18.7 cm3 (80–158 cm 3) (р>0.05). Both groups had favorable morphological characteristics. Results. The average surgery time difference was 65 minutes in favor of the open prostatectomy (p<0.05). The average blood loss volume in the study group was 282.5 ± 227.5 ml (50–1000 ml). The average blood loss volume in the group with open prostatectomy was 505.7 ± 382.3 ml (50–2000 ml). Positive surgical margin in the robotic prostatectomy was not detected, at 6.9 % in the group with open prostatectomy (p<0.05). According to the criterion of urinary continence, the best results were obtained in the group of robotic prostatectomy (p<0.05). Overall and relapse-free 5-year survival did not show a statistically significant difference. Conclusion. The use of robotic prostatectomy in a group of patients with a large prostate volume (≥ 80 cm3) allows us to achieve better functional and oncological outcomes.

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