Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Oncological and functional outcomes following robot-assisted laparoscopic radical prostatectomy at a single institution: a minimum 5-year follow-up

  • Kang, Jun-Koo (Department of Urology, Kyungpook National University School of Medicine) ;
  • Chung, Jae-Wook (Department of Urology, Kyungpook National University School of Medicine) ;
  • Chun, So Young (Biomedical Research Institute, Kyungpook National University Hospital) ;
  • Ha, Yun-Sok (Department of Urology, Kyungpook National University School of Medicine) ;
  • Choi, Seock Hwan (Department of Urology, Kyungpook National University School of Medicine) ;
  • Lee, Jun Nyung (Department of Urology, Kyungpook National University School of Medicine) ;
  • Kim, Bum Soo (Department of Urology, Kyungpook National University School of Medicine) ;
  • Yoon, Ghil Suk (Department of Pathology, Kyungpook National University School of Medicine) ;
  • Kim, Hyun Tae (Department of Urology, Kyungpook National University School of Medicine) ;
  • Kim, Tae-Hwan (Department of Urology, Kyungpook National University School of Medicine) ;
  • Kwon, Tae Gyun (Department of Urology, Kyungpook National University School of Medicine)
  • Received : 2018.01.25
  • Accepted : 2018.06.01
  • Published : 2018.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: To evaluate mid-term oncological and functional outcomes in patients with prostate cancer treated by robot-assisted laparoscopic radical prostatectomy (RALP) at our institution. Methods: We retrospectively reviewed the medical records of 128 patients with prostate cancer who underwent RALP at our institution between February 2008 and April 2010. All patients enrolled in this study were followed up for at least 5 years. We analyzed biochemical recurrence (BCR)-free survival using a Kaplan-Meier survival curve analysis and predictive factors for BCR using multivariate Cox regression analysis. Continence recovery rate, defined as no use of urinary pads, was also evaluated. Results: Based on the D'Amico risk classification, there were 30 low-risk patients (23.4%), 47 intermediaterisk patients (38.8%), and 51 high-risk patients (39.8%), preoperatively. Based on pathological findings, 50.0% of patients (64/128) showed non-organ confined disease (${\geq}T3a$) and 26.6% (34/128) had high grade disease (Gleason score ${\geq}8$). During a median follow-up period of 71 months (range, 66-78 months), the frequency of BCR was 33.6% (43/128) and the median BCR-free survival was 65.9 (0.4-88.0) months. Multivariate Cox regression analysis revealed that high grade disease (Gleason score ${\geq}8$) was an independent predictor for BCR (hazard ratio=4.180, 95% confidence interval=1.02-17.12, p=0.047). In addition, a majority of patients remained continent following the RALP procedure, without the need for additional intervention for post-prostatectomy incontinence. Conclusion: Our study demonstrated acceptable outcomes following an initial RALP procedure, despite 50% of the patients investigated demonstrating high-risk features associated with non-organ confined disease.

Keywords

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29. https://doi.org/10.3322/caac.21254
  2. Han HH, Park JW, Na JC, Chung BH, Kim CS, Ko WJ. Epidemiology of prostate cancer in South Korea. Prostate Int 2015;3:99-102. https://doi.org/10.1016/j.prnil.2015.06.003
  3. Chopra S, Srivastava A, Tewari A. Robotic radical prostatectomy: the new gold standard. Arab J Urol 2012;10:23-31. https://doi.org/10.1016/j.aju.2011.12.005
  4. D'Amico AV, Moul J, Carroll PR, Sun L, Lubeck D, Chen MH. Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 2003;21:2163-72. https://doi.org/10.1200/JCO.2003.01.075
  5. Luciani LG, Mattevi D, Mantovani W, Cai T, Chiodini S, Vattovani V, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a comparative analysis of the surgical outcomes in a single regional center. Curr Urol 2017;11:36-41. https://doi.org/10.1159/000447192
  6. Nossiter J, Sujenthiran A, Charman SC, Cathcart PJ, Aggarwal A, Payne H, et al. Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. Br J Cancer 2018;118:489-94. https://doi.org/10.1038/bjc.2017.454
  7. Haglind E, Carlsson S, Stranne J, Wallerstedt A, Wilderang U, Thorsteinsdottir T, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial. Eur Urol 2015;68:216-25. https://doi.org/10.1016/j.eururo.2015.02.029
  8. Kang YJ, Kim HS, Jang WS, Kwon JK, Yoon CY, Lee JY, et al. Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin. BMC Cancer 2017;17:321. https://doi.org/10.1186/s12885-017-3307-4
  9. Menon M, Bhandari M, Gupta N, Lane Z, Peabody JO, Rogers CG, et al. Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. Eur Urol 2010;58:838-46. https://doi.org/10.1016/j.eururo.2010.09.010
  10. Rajan P, Hagman A, Sooriakumaran P, Nyberg T, Wallerstedt A, Adding C, et al. Oncologic outcomes after robot-assisted radical prostatectomy: a large European single-centre cohort with median 10-year follow-up. Eur Urol Focus 2018;4:351-9. https://doi.org/10.1016/j.euf.2016.10.007
  11. Sooriakumaran P, Haendler L, Nyberg T, Gronberg H, Nilsson A, Carlsson S, et al. Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum follow-up time of 5 years. Eur Urol 2012;62:768-74. https://doi.org/10.1016/j.eururo.2012.05.024
  12. Lee SH, Seo HJ, Lee NR, Son SK, Kim DK, Rha KH. Robotassisted radical prostatectomy has lower biochemical recurrence than laparoscopic radical prostatectomy: systematic review and meta-analysis. Investig Clin Urol 2017;58:152-63. https://doi.org/10.4111/icu.2017.58.3.152
  13. Abdel Raheem A, Kim DK, Santok GD, Alabdulaali I, Chung BH, Choi YD, et al. Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up. Int J Urol 2016;23:765-74. https://doi.org/10.1111/iju.13151
  14. Diaz M, Peabody JO, Kapoor V, Sammon J, Rogers CG, Stricker H, et al. Oncologic outcomes at 10 years following robotic radical prostatectomy. Eur Urol 2015;67:1168-76. https://doi.org/10.1016/j.eururo.2014.06.025
  15. Shao IH, Chang YH, Hou CM, Lin ZF, Wu CT. Predictors of short-term and long-term incontinence after robot-assisted radical prostatectomy. J Int Med Res 2018;46:421-9. https://doi.org/10.1177/0300060517715396
  16. Kadono Y, Ueno S, Kadomoto S, Iwamoto H, Takezawa Y, Nakashima K, et al. Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: nerve-sparing technique contributes to the reduction of postprostatectomy incontinence. Neurourol Urodyn 2016;35:1034-9. https://doi.org/10.1002/nau.22877
  17. Honda M, Kawamoto B, Morizane S, Hikita K, Muraoka K, Sejima T, et al. A prognostic model for predicting urinary incontinence after robot-assisted radical prostatectomy. Int J Med Robot 2017;13. doi: 10.1002/rcs.1780.

Cited by

  1. Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy vol.11, pp.1, 2018, https://doi.org/10.1038/s41598-021-93860-y