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MAAUA 68th Annual Meeting Abstracts
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Robotic-Assisted Laparoscopic Prostatectomy and Open Radical Retropubic Prostatectomy for Locally Advanced Prostate Cancer: A Comparison of Oncologic Outcomes
Keith J Kowalczyk1, Anup A Vora1, Keith A Christiansen1, *Hanna Nissim1, John H Lynch1, Reza Ghasemian1, Mohan Verghese1, Edward Uchio2, Jonathan J Hwang1
1Georgetown University Hospital/Washington Hospital Center, Washington, DC;2Yale University School of Medicine, New Haven, CT
Introduction:
Robotic Assisted Laparoscopic Prostatectomy (RALP) offers minimally invasive treatment for localized prostate cancer (CaP) with comparable outcomes to Open Radical Retropubic Prostatectomy (RRP). However, the oncologic efficacy of RALP in locally advanced CaP is less clear. We report and compare our experience with RALP and RRP in men with locally advanced CaP.
Materials & Methods:
For patients undergoing RALP, data was collected prospectively as part of an IRB approved database. For those undergoing RRP, data was retrospectively collected. Patients with stage pT3 or greater CaP were identified. Clinicopathologic features were recorded. We further examined the effect of the RALP surgical learning curve on the incidence of positive surgical margins after 300 cases. Results between each cohort were compared.
Results:
From 1997 to 2009, 761 patients underwent RALP and 342 underwent RRP at our institution. Ninety-six patients in the RALP group and 84 in the RRP group had pT3 or greater disease. Overall positive surgical margin rates for pT3 disease in RALP and RRP were 54.2% and 55.4%, respectively. A statistically significant trend towards lower positive margin rate in the RALP group was seen after 300 cases (66.7% first 300 cases vs. 45.0% latter 461 cases).
Conclusions:
Two out of 3 men undergoing RALP with pT3 CaP had positive margins during our initial experience. With increasing experience, the positive margin rate decreased significantly and was comparable to that of RRP. We conclude that RALP and RRP have comparable oncologic outcomes in advanced CaP, especially with higher volume robotic surgeons.
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