- Email: [email protected]
451 NOMOGRAMS TO PREDICT BIOCHEMICAL RECURRENCE AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY
21.8ml; 12m: 19.2ml vs. 20.2ml). However, the relative volume reduction was still significantly lower in the LV-Group at 6 weeks (32% vs. 39%, p<0.001), 6 months (37% vs. 49%, p<0.001) and 12 months (38% vs. 48%, p=0.02). An increase of volume reduction between catheter removal and 12 months measurement was detectable in both groups but significantly higher after LV (p= 0.02). Subjective and objective outcome parameters improved significantly in both groups and were comparable between the groups after 6 weeks, 6 and 12 months. Conclusions: 120W LBO-LV is an efficient procedure for prostatic de-obstruction evidenced by an absolute tissue ablation not significantly different to that after TURP. However, TURP seems to be superior due to a higher ablation in relation to the initial volume. The investigated outcome parameters show that this difference has no clinical impact after a follow-up period up to 12 months. The lower volume reduction measured after catheter removal compared to that measured after 12 months suggests that prostatic swelling occurs early after LV and then decreases subsequently.
Poster Session 38 OUTCOMES IN LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY Sunday, 20 March, 12.15-13.45, Hall E2
450
Patterns of biochemical recurrence after robot-assisted radical prostatectomy. Results of patients with a minimum follow-up of 5 years
Suardi N., Willemsen P., Pauwels E., De Wil P., De Naeyer G., Schatteman P., Carpentier P., Mottrie A.M. O.L.V. Clinic, Dept. of Urology, Aalst, Belgium Introduction & Objectives: Robot-assisted radical prostatectomy (RARP) represents a widely used treatment modality for organ-confined (OC) prostate cancer (PCa). Despite the fast diffusion of the technique, no long-term results are available yet for patients treated with RARP. We address the oncological outcomes after RARP in a series of patients with at least 5 years of follow-up. Materials & Methods: Between 2003 and 2005, 184 consecutive patients with OC PCa underwent RARP by two surgeons at a single institution. All patients reached the 5-year follow-up landmark in 2010. Kaplan-Meier and life tables analyses targeted the rates and patterns of overall mortality, cancer-specific mortality and biochemical recurrence (BCR) according to pathological parameters. Cox regression analyses addressed predictors of BCR. Results: Mean and median age were 61.9 and 63 years, respectively. Mean and median PSA were 8.7 and 7.5 ng/ml respectively. At final pathology 117 (62.5%), 56 (30%) and 14 (7.5%) patients had organ confined disease, extracapsular extension (ECE) and seminal vesicle invasion (SVI), respectively. Pathological Gleason score was 2-6, 7 and 8-10 in 111 (60.5%), 53 (29%) and 20 (10.5%), respectively. Positive surgical margin(s) were found in 3 (2.5%) and in 26 (37%) patients with OC and non-OC disease, respectively. Mean and median follow-up were 69.3 and 67.5 months, respectively. Seven patients (3.8%) were lost to follow-up. Five years after surgery, 1 and 10 patients died of either PCa or other causes, respectively. Mean time to BCR was 83.8 months (median not reached). The 3, 5 and 7 years BCRfree survival rates were 91, 84 and 81% respectively. The 5-year BCR-free survival rate was 87 and 68% for patients with negative and positive surgical margins respectively (p<0.001). The 5-year BCR-free survival rate was 90, 84 and 43% for patients with OC disease, ECE and SVI, respectively (p<0.001). The 5-year BCR-free survival rate was 88, 82 and 65% for patients with pathological Gleason score 2-6, 7 and 8-10, respectively (p<0.001). Univariable analyses showed that higher PSA, higher pathological Gleason score and presence of ECE and SVI were significantly associated with BCR. At multivariable analyses, SVI represented the strongest predictor of biochemical recurrence. Conclusions: We report on the longest available follow-up in patients treated with RARP. The oncological outcomes of patients with clinically localized PCa treated with RARP are highly satisfactory. The majority of recurrences are observed within the first 3 years after surgery. PSA level at surgery and pathologically unfavorable characteristics are associated with higher risk of BCR after RARP. Patients with SVI are at the highest risk of BCR.
451
Nomograms to predict biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy
Sooriakumaran P., John M., Srivastava A., El-Douaihy Y., Grover S., Bhagat D., Rajan S., Leung R., Tewari A.K. Weill Cornell Medical College, Dept. of Urology, New York, United States of America Introduction & Objectives: Predictors of biochemical recurrence after roboticassisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical
Eur Urol Suppl 2011;10(2):154
recurrence such that potential patients could be adequately counselled about their risk of recurrence before undergoing RALP. Materials & Methods: 774 patients with at least 3 year follow up had undergone RALP by a single surgeon at our institution. Biochemical recurrence was defined as a postoperative PSA >0.2 ng/ml. Multivariable logistic regression models were used to develop the biochemical recurrence predictive nomograms: nomogram 1- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion; nomogram 2- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion, nerve sparing, positive surgical margins (none, unifocal, or multifocal). The predictive accuracy of the models was assessed in terms of discrimination and calibration. Predictors of biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical recurrence such that potential patients could be adequately counselled about their risk of recurrence before undergoing RALP. Results: Both nomograms discriminated well between patients that recurred and those that did not (bootstrap corrected c-indices of 0.766 and 0.806 for nomograms 1 and 2 respectively). Nomogram 1 was well calibrated, but nomogram 2 overpredicted the probability of biochemical recurrence in patients at >30% risk. Conclusions: Our nomogram based on age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, and perineural invasion on preoperative biopsy has a good predictive ability to differentiate between RALP-treated patients that biochemically recur by 3 years from those that do not. Adding nerve sparing and surgical margin status further improved discriminatory ability but at the expense of over-prediction for patients at high risk. These nomograms may be used to guide the use of nerve sparing and the management of positive margins in men undergoing RALP for clinically localized prostate cancer.
452
Rectal injury is a potential complication of robotic radical prostatectomy
Kheterpal E., Bhandari A., Trinh Q.D., Siddiqui S., Pokala N., Sukumar S., Peabody J.O., Menon M. Henry Ford Health System, Vattikuti Urology Institute, Detroit, United States of America Introduction & Objectives: Rectal injury is a potential complication of radical prostatectomy. We reviewed the incidence and management of rectal injury in 4,400 consecutive cases of robotic radical prostatectomy (RRP) at a single institution. Materials & Methods: Between September 2001 and September 2009, 4,400 patients underwent a RRP. We reviewed the intraoperative and postoperative management of patients with rectal injuries. Once recognized the rectal injuries were closed in 2 layers. Clear liquids were started the day after surgery. Healing of vesicourethral anastomosis was confirmed by cystogram between 5-14 days post-operatively. Results: Rectal injuries were identified in 10 patients (0.2%). Mean patient age was 58.6 years (range 44 to 68) and mean BMI was 25.8 kg/m2 (range 22 to 29). Mean PSA was 7.1 ng/ml (range 0.9 to 14.8) and mean prostate weight was 58.9 grams (range 22 to 102). Clinical stage was T1c, T2a, T2c in 7, 2, and 1 patient, respectively. Preoperative Gleason score was 6, 7 and 8 in 3, 3 and 4 patients, respectively. All rectal injuries were diagnosed and repaired intraoperatively. Seven patients underwent nerve sparing procedures. Of the 10 patients, 9 had an uneventful post-operative course. Average urethral catheterization time in these patients was 14 days (range 6 to 21 days) and mean hospital stay was 2.2 days (range 1 to 5 days). One patient had gross fecal spillage and developed a rectourethral fistula, which required a delayed diverting colostomy. There was no perioperative mortality. Conclusions: We report a low incidence of rectal injury during robotic radical prostatectomy. We also demonstrate that rectal injuries can be managed primarily with a meticulous closure with minimum morbidity.
453
Implications of laparoscopic inguinal hernia repair on open, laparoscopic and robotic radical prostatectomy
Spernat D.M.G.1, Woo H.H.2, Sofield D.3, Moon D.4, Louie Johnsun M.5 1 Sydney Adventist Hospital, Dept. of Urology, Sydney, Australia, 2Sydney Medical School, Sydney Adventist Hospital, University of Sydney, Dept. of Urology, Sydney, Australia, 3Bethesda Hospital, Dept. of Urology, Perth, Australia, 4Royal Melbourne Hospital, Dept. of Urology, Melbourne, Australia, 5Gosford Private Hospital, Dept. of Urology, Gosford, Australia Introduction & Objectives: Radical Prostatectomy (RP) can be a challenging operation. Further, tissue planes can be compromised by previous Laparoscopic Inguinal Hernia Repair (LIHR). Surgeons have anecdotally reported that RP has had to be abandoned due to the difficult access after LIHR. We prospectively collected data from four experienced prostate surgeons from separate institutions. Each surgeon has a different technique for RP, and thus we report on our experience with open, laparoscopic and robotic assisted RP. Our objective was to evaluate the success rate of performing RP with the three most common operative techniques,
Poster Session 38 OUTCOMES IN LAPAROSCOPIC AND ROBOTIC RADICAL PROSTATECTOMY Sunday, 20 March, 12.15-13.45, Hall E2
450
Patterns of biochemical recurrence after robot-assisted radical prostatectomy. Results of patients with a minimum follow-up of 5 years
Suardi N., Willemsen P., Pauwels E., De Wil P., De Naeyer G., Schatteman P., Carpentier P., Mottrie A.M. O.L.V. Clinic, Dept. of Urology, Aalst, Belgium Introduction & Objectives: Robot-assisted radical prostatectomy (RARP) represents a widely used treatment modality for organ-confined (OC) prostate cancer (PCa). Despite the fast diffusion of the technique, no long-term results are available yet for patients treated with RARP. We address the oncological outcomes after RARP in a series of patients with at least 5 years of follow-up. Materials & Methods: Between 2003 and 2005, 184 consecutive patients with OC PCa underwent RARP by two surgeons at a single institution. All patients reached the 5-year follow-up landmark in 2010. Kaplan-Meier and life tables analyses targeted the rates and patterns of overall mortality, cancer-specific mortality and biochemical recurrence (BCR) according to pathological parameters. Cox regression analyses addressed predictors of BCR. Results: Mean and median age were 61.9 and 63 years, respectively. Mean and median PSA were 8.7 and 7.5 ng/ml respectively. At final pathology 117 (62.5%), 56 (30%) and 14 (7.5%) patients had organ confined disease, extracapsular extension (ECE) and seminal vesicle invasion (SVI), respectively. Pathological Gleason score was 2-6, 7 and 8-10 in 111 (60.5%), 53 (29%) and 20 (10.5%), respectively. Positive surgical margin(s) were found in 3 (2.5%) and in 26 (37%) patients with OC and non-OC disease, respectively. Mean and median follow-up were 69.3 and 67.5 months, respectively. Seven patients (3.8%) were lost to follow-up. Five years after surgery, 1 and 10 patients died of either PCa or other causes, respectively. Mean time to BCR was 83.8 months (median not reached). The 3, 5 and 7 years BCRfree survival rates were 91, 84 and 81% respectively. The 5-year BCR-free survival rate was 87 and 68% for patients with negative and positive surgical margins respectively (p<0.001). The 5-year BCR-free survival rate was 90, 84 and 43% for patients with OC disease, ECE and SVI, respectively (p<0.001). The 5-year BCR-free survival rate was 88, 82 and 65% for patients with pathological Gleason score 2-6, 7 and 8-10, respectively (p<0.001). Univariable analyses showed that higher PSA, higher pathological Gleason score and presence of ECE and SVI were significantly associated with BCR. At multivariable analyses, SVI represented the strongest predictor of biochemical recurrence. Conclusions: We report on the longest available follow-up in patients treated with RARP. The oncological outcomes of patients with clinically localized PCa treated with RARP are highly satisfactory. The majority of recurrences are observed within the first 3 years after surgery. PSA level at surgery and pathologically unfavorable characteristics are associated with higher risk of BCR after RARP. Patients with SVI are at the highest risk of BCR.
451
Nomograms to predict biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy
Sooriakumaran P., John M., Srivastava A., El-Douaihy Y., Grover S., Bhagat D., Rajan S., Leung R., Tewari A.K. Weill Cornell Medical College, Dept. of Urology, New York, United States of America Introduction & Objectives: Predictors of biochemical recurrence after roboticassisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical
Eur Urol Suppl 2011;10(2):154
recurrence such that potential patients could be adequately counselled about their risk of recurrence before undergoing RALP. Materials & Methods: 774 patients with at least 3 year follow up had undergone RALP by a single surgeon at our institution. Biochemical recurrence was defined as a postoperative PSA >0.2 ng/ml. Multivariable logistic regression models were used to develop the biochemical recurrence predictive nomograms: nomogram 1- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion; nomogram 2- age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, perineural invasion, nerve sparing, positive surgical margins (none, unifocal, or multifocal). The predictive accuracy of the models was assessed in terms of discrimination and calibration. Predictors of biochemical recurrence after robotic-assisted laparoscopic radical prostatectomy (RALP) are not well reported in the literature. We wanted to investigate preoperative predictors as well as the influence of nerve sparing and positive surgical margin status on 3-year biochemical recurrence such that potential patients could be adequately counselled about their risk of recurrence before undergoing RALP. Results: Both nomograms discriminated well between patients that recurred and those that did not (bootstrap corrected c-indices of 0.766 and 0.806 for nomograms 1 and 2 respectively). Nomogram 1 was well calibrated, but nomogram 2 overpredicted the probability of biochemical recurrence in patients at >30% risk. Conclusions: Our nomogram based on age, BMI, PSA density, clinical stage, biopsy Gleason, percent positive cores, and perineural invasion on preoperative biopsy has a good predictive ability to differentiate between RALP-treated patients that biochemically recur by 3 years from those that do not. Adding nerve sparing and surgical margin status further improved discriminatory ability but at the expense of over-prediction for patients at high risk. These nomograms may be used to guide the use of nerve sparing and the management of positive margins in men undergoing RALP for clinically localized prostate cancer.
452
Rectal injury is a potential complication of robotic radical prostatectomy
Kheterpal E., Bhandari A., Trinh Q.D., Siddiqui S., Pokala N., Sukumar S., Peabody J.O., Menon M. Henry Ford Health System, Vattikuti Urology Institute, Detroit, United States of America Introduction & Objectives: Rectal injury is a potential complication of radical prostatectomy. We reviewed the incidence and management of rectal injury in 4,400 consecutive cases of robotic radical prostatectomy (RRP) at a single institution. Materials & Methods: Between September 2001 and September 2009, 4,400 patients underwent a RRP. We reviewed the intraoperative and postoperative management of patients with rectal injuries. Once recognized the rectal injuries were closed in 2 layers. Clear liquids were started the day after surgery. Healing of vesicourethral anastomosis was confirmed by cystogram between 5-14 days post-operatively. Results: Rectal injuries were identified in 10 patients (0.2%). Mean patient age was 58.6 years (range 44 to 68) and mean BMI was 25.8 kg/m2 (range 22 to 29). Mean PSA was 7.1 ng/ml (range 0.9 to 14.8) and mean prostate weight was 58.9 grams (range 22 to 102). Clinical stage was T1c, T2a, T2c in 7, 2, and 1 patient, respectively. Preoperative Gleason score was 6, 7 and 8 in 3, 3 and 4 patients, respectively. All rectal injuries were diagnosed and repaired intraoperatively. Seven patients underwent nerve sparing procedures. Of the 10 patients, 9 had an uneventful post-operative course. Average urethral catheterization time in these patients was 14 days (range 6 to 21 days) and mean hospital stay was 2.2 days (range 1 to 5 days). One patient had gross fecal spillage and developed a rectourethral fistula, which required a delayed diverting colostomy. There was no perioperative mortality. Conclusions: We report a low incidence of rectal injury during robotic radical prostatectomy. We also demonstrate that rectal injuries can be managed primarily with a meticulous closure with minimum morbidity.
453
Implications of laparoscopic inguinal hernia repair on open, laparoscopic and robotic radical prostatectomy
Spernat D.M.G.1, Woo H.H.2, Sofield D.3, Moon D.4, Louie Johnsun M.5 1 Sydney Adventist Hospital, Dept. of Urology, Sydney, Australia, 2Sydney Medical School, Sydney Adventist Hospital, University of Sydney, Dept. of Urology, Sydney, Australia, 3Bethesda Hospital, Dept. of Urology, Perth, Australia, 4Royal Melbourne Hospital, Dept. of Urology, Melbourne, Australia, 5Gosford Private Hospital, Dept. of Urology, Gosford, Australia Introduction & Objectives: Radical Prostatectomy (RP) can be a challenging operation. Further, tissue planes can be compromised by previous Laparoscopic Inguinal Hernia Repair (LIHR). Surgeons have anecdotally reported that RP has had to be abandoned due to the difficult access after LIHR. We prospectively collected data from four experienced prostate surgeons from separate institutions. Each surgeon has a different technique for RP, and thus we report on our experience with open, laparoscopic and robotic assisted RP. Our objective was to evaluate the success rate of performing RP with the three most common operative techniques,