1 / 19

50 Vs 50

50 Vs 50. A Comparison of the Oncologic Outcomes of Retropubic Prostatectomy and Robotic Prostatectomy. Chris Ogden Tim Christmas Jordan Durrant Khalid A E Shendi Rene Woderich. Background. The Robotic Prostatectomy Program at The Royal Marsden began in late 2006 , led by Chris Ogden.

twork
Télécharger la présentation

50 Vs 50

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 50 Vs 50 A Comparison of the Oncologic Outcomes of Retropubic Prostatectomy and Robotic Prostatectomy Chris Ogden Tim Christmas Jordan Durrant Khalid A E Shendi Rene Woderich

  2. Background • The Robotic Prostatectomy Program at The Royal Marsden began in late 2006 , led by Chris Ogden. • Previously, Retropubic Prostatectomy was performed by Tim Christmas. • During this Transition period, a comparison of the two methods was made. • Chris Ogden is now proctoring other Institutions making this transition.

  3. Introduction • Beginning on 1st January 2007, the details of 50 consecutive Robotic Assisted Laparoscopic Prostatectomy cases were entered into a database and compared with the last 50 consecutive Radical Retropubic Prostatectomy cases.

  4. Methods • Patient Data: • Age • Pre-Operative PSA, Staging, Gleason Score • Pre-Operative Haemoglobin • Pre-Operative MRI Staging

  5. Methods • Measured Outcomes were: • Anaesthetic Time • Post-Operative Haemoglobin • Number of Nights in Hospital • Post-Operative Histopathology • Positive Margin Rate

  6. Methods • All patients had 12 months follow-up with 3 monthly PSA checks.

  7. Surgical Technique • Radical Retropubic Prostatectomy • Midline Vertical Skin Incision • Bladder Neck and Nerve Preserving • Yates Drain • Planned In-Patient Stay of 7-10 days, TWOC prior to discharge

  8. Surgical Technique • Robot Assisted Laparoscopic Prostatectomy • 6 ports • Robinson’s drain for 12-24 hours • Planned In-Patient Stay of 1-2 days • TWOC as Out-Patient at 10 days

  9. The Patient Groups • 50 consecutive patients in each group. Non-randomised, no matching. • Median Age • Retropubic : 62 • Robotic : 61 • Median PSA • Retropubic : 8.2 • Robotic : 7.1 • Percentage with MRI T3 Staging Pre-Op • Retropubic : 6% • Robotic : 8%

  10. The Surgery • Median Time Under Anaesthesia • Retropubic : 95 mins • Robotic : 270 mins • Percentage Patients with Hb Drop >4g/dL • Retropubic : 40% • Robotic : 12% • Median Number of Post-Op Nights in Hospital • Retropubic : 9 nights • Robotic : 2 nights

  11. Reduction in Hospital Stay significant, un-paired T test shows p=<0.0001

  12. Difference in blood loss significant, un-paired T test shows p=0.0002

  13. Oncologic Outcomes • Stage >pT3 on Final Post-Op Histology • Retropubic : 32% • Robotic : 18% • Positive Margin Rate in pT2 Tumours • Retropubic : 24% • Robotic : 14%

  14. 12 Month Follow-Up • Biochemical Recurrence in First 12 months • Retropubic : 22% • Robotic : 4%

  15. Conclusions • The two groups are comparable, however, the lower PSA recurrence rate in Robotic Group is in part related to lower incidence of T3 tumours. • There are early Oncologic advantages in making the transition to Robotic Prostatectomy.

  16. Conclusions • The Robotic patients have a shorter hospital stay and less morbidity from blood loss.

  17. The Future • Our database now has over 200 cases, we look forward to presenting this data a WRS. • The data shows a consistent Positive Margin Rate of 14.7%. • 27% of patients are discharged within 24 hours of surgery.

  18. The Future • PSA recurrence within 12 months confined to 7.6% of patients. • 85% of patients pad-free at 12 months. • Median console time of 145 minutes.

  19. The End • Any questions?

More Related