Robotic assisted radical prostatectomia and large prostate
Sandi Poteko, Nado Vodopija, Klemen Jagodič
Department of Urology, General Hospital Celje, Slovenia
OBJECTIVE:
Radical prostatectomy is common surgical treatment of localized prostate cancer. Robotic assisted radical prostatectomia (RARP) offers advantages compared with other treatments. Large prostate (prostate volume ˃ 70 g) are challenging cases for experienced surgeons. Pasadena Consensus Panel did not reach any consesnsus about the defiition of experienced surgeon. Data from the literature classifies surgeons as high volume ( >40 procedures per year) or low volume (<40 procedures per year ). We analyzed the perioperative and recovery outcomes of first 400 cases of RARP performed at our department from May 2010 and January 2013. There were 14 patients with prostate volume ˃ 70 g.
MATERIALS AND METHODS:
Operative and recovery data for 14 men with localised prostate cancer and average prostate volume 86 g (70 g -107 g) were reviewed. Half of patients were treated for BPH with 5α-reductase inhibitors before RARP. Data include age, medical treatment of BPH, PSA level, Gleason score, console time, estimated blood loss, time of catheterisation, complications and continence recovery.
RESULTS:
The age of patients varied from 60 – 74 years and PSA from 4,0 to 12,2 ng/ml. Preoperative biopsy GS 6 had 9 patients, GS 7 had 5 patients, all with cT1-2. The mean consola time was 160 min. (70-220min.). Estimated blood loss was 155 ml (50-450ml) with no need for transfusion. In a subgroup of RARP number 150-300 the mean consola time was 145 min, and estimated blood loss was 150 ml. There was one rectal injury, recognised intraoperatively and treated with sutures in two layers. Hospital stay for 13 patients was 3 days and catheter was removed after 7 days. A patient with rectal injury had a catheter inserted for 15 days. Histological report was pT2a, GS 6 for 6 patients and pT2c, GS 7 for 6 patients. Two patients were pT0. Both were preoperatively treated with 5α-reductase inhibitors for many years. All reports were without positive surgical margins (R0 resection). The biochemical reccurence rate is zero, till now. Continence rate after 3 months is 9/14, ( 60%).
CONCLUSION:
RARP for a patient with a large prostate is a challenging procedure also for experienced surgeon. Our results are comparable with our subgroup of RARP number 150-300 and results in literature.