scholarly journals Salvage versus primary robot-assisted radical prostatectomy: a propensity-matched comparative effectiveness study from a high-volume tertiary centre

2021 ◽  
Author(s):  
Arjun Nathan ◽  
Monty Fricker ◽  
Ruben De Groote ◽  
Amandeep Arora ◽  
Yuzhi Phuah ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
High Volume ◽  
Patient Characteristics ◽  
Primary Treatment ◽  
Complication Rates ◽  
Risk Propensity ◽  
Robot Assisted ◽  
Oncological Outcomes ◽  
Tertiary Centre ◽  
Primary Groups

Introduction Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between similar-risk, propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Methods 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups (p=0.310). Median (IQR) follow-up was 16 (10, 30) and 21 (13, 33) months in the salvage and primary groups. BCR rates were 30.8% and 13.7% in the salvage and primary groups (p<0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups (p=0.160). Erectile dysfunction was 95.2% and 77.4% in the salvage and primary groups (p<0.001). On comparison of whole and focal gland groups, biochemical recurrence was 33.3% and 29.1% (p=0.687), pad-free continence rates were 66% and 89.3% (p=0.001), and ED rates were 98.3% and 93% (p=0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar compared to after whole gland therapy but continence outcomes are superior.

scholarly journals 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Nathan ◽  
M Fricker ◽  
R De Groote ◽  
A Arora ◽  
Y Phuah ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
High Volume ◽  
Patient Characteristics ◽  
Primary Treatment ◽  
Complication Rates ◽  
Robot Assisted ◽  
Oncological Outcomes ◽  
Tertiary Centre ◽  
Comparative Effectiveness Study ◽  
Primary Groups

Abstract Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p &lt; 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p &lt; 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

scholarly journals Feasibility of robot-assisted radical prostatectomy in men at senior age ≥75 years: perioperative, functional, and oncological outcomes of a high-volume center

2021 ◽  
Vol 25 (1) ◽  
pp. 8-16
Author(s):  
Sami-Ramzi Leyh-Bannurah ◽  
Christian Wagner ◽  
Andreas Schuette ◽  
Nikolaos Liakos ◽  
Theodoros Karagiotis ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
High Volume ◽  
Robot Assisted ◽  
Oncological Outcomes ◽  
High Volume Center

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

Sign in / Sign up

Export Citation Format

Share Document