- Email: [email protected]
PE08: Early and late complications after robot-assisted radical cystectomy with totally intracorporeal urinary diversion
18
U N M O D E R A T E D P O S T E R P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
the bladder neck – in case of 4 patients and pheochromocytoma with the lesion of the bladder – 1 patient. Criteria for an inclusion of patients: a non-multiple bladder cancer localized in the bladder neck with the level of invasion of the tumor within the muscle layer T2a–b, with the N0, G1–2 level of differentiation. Three robotic manipulators performed this operation with the use of bipolar clip, monopolar scissors, clip and needle holder. The first stage: cystoscopy and stenting of the ureters. The second stage: robot-assisted resection with transbladder light illumination. The third stage: pelvic lymphadenectomy. The defect of the rear wall was taken in by the thread V-Loc, 3-0 with the one- row continuous suture. Resection of the mouth of the ureter with the formation of mucoso-muscle cuff on the ureter-stent – 2 patients. Results: Median observations of patients ranged from 11 to 16 months (13.3 months). Recurrence of the tumor and metastases have not been revealed. Functional results in Table 1. Table 1. Results of the robotic treatment of the bladder cancer and pheochromocytoma with the lesion of the bladder Sex Age
f m m f m
Diagnosis
62 Pheochromocytoma of the bladder 65 Bladder cancer pT2aN0M0G2 69 Bladder cancer pT2bN0M0G2 67 Bladder cancer pT2bN0M0G2 57 Bladder cancer pT2aN0M0G2
Duration of Volume of Complications Duration of of the blood loss hospital stay operation (ml) (days) 2 h 30 min
50
none
10
2 h 40 min
80
none
8
3 h 20 min
100
none
9
2 h 15 min
60
none
12
2 h 30 min
100
none
7
Conclusions: Bladder sparing operations in the form of robotic resection of the bladder neck are the operations of choice for muscleinvasive bladder cancer and pheochromocytoma with the lesion of the bladder neck, which allow to remove radically the tumor, to resect the ureter with one-stage the formation of mucoso-muscle cuff on the ureter-stent, to perform the pelvic lymphadenectomy, and to preserve the urinary bladder in a large amount compared with the open resection and TUR of the bladder. PE07 Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open surgery A. Wallerstedt 1 , S. Tyritzis 1 , T. Thorsteinsdottir 2 , S. Carlsson 1 , J. Stranne 3 , O. Gustafsson 4 , J. Hugosson 3 , A. Bjartell 5 , U. Wilderäng 2 , P. Wiklund 1 , G. Steineck 2 , E. Haglind 6 . 1 Karolinska Institutet, Dept. of Molecular Medicine and Surgery, Section of Urology, Stockholm, Sweden; 2 Sahlgrenska Academy, Dept. of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Gothenburg, Sweden; 3 Sahlgrenska Academy, Dept. of Urology, Institute of Clinical Sciences, Gothenburg, Sweden; 4 Karolinska Institutet, Dept. of Molecular Department of Clinical Science, Intervention and Technology, Stockholm, Sweden; 5 Lund University, Dept. of Urology, Skåne University Hospital, Lund, Sweden; 6 Sahlgrenska Academy, Dept. of Surgery, Institute of Clinical Sciences, Gothenburg, Sweden Introduction & Objectives: Robot-assisted laparoscopic radical prostatectomy has become a widespread technique without randomized trials showing clear benefits in outcomes over open prostatectomy. The objective of this study was to evaluate patient-reported outcomes three months after surgery in robot-assisted laparoscopic compared to open retropubic radical prostatectomy. Material & Methods: Data derived from LAPPRO; a prospective controlled trial where data was collected with validated patient questionnaires and by health-care professionals from all men diagnosed with prostate cancer and planned for radical prostatectomy at 14 participating centers. Difference in outcome between the two treatment
groups were analyzed using logistic regression, with and without adjustment for possible confounders. Results: Questionnaires were received from 2517 (94%) patients. The robotic group had lower perioperative bleeding, P=<0.001, shorter time in recovery unit, P=0.05, and shorter hospital stay, P=<0.001. Operating time was shorter with the open technique, P=<0.001. Reoperation during initial hospital stay was more frequent after open surgery, after adjusting for tumour factors and lymph-node dissection, OR 0.31 (95% CI 0.11–0.90). Men operated with open technique were more likely to seek health-care, within 90 days after surgery, compared to men operated by the robotic technique, P=0.003. It was more common to seek health-care for cardiovascular reasons in the open group after adjusting for non-tumour and tumour-specific confounders, OR 0.63 (95% CI 0.42–0.94). Gastrointestinal and psychological reasons for seeking health care were more common in the open group but was affected by adjusting for non-tumour and tumour specific factors. The readmittence rate was not statistically different between the groups. A limitation of the study is the lack of a standardized tool for the assessment of the adverse events. Conclusions: Patient-reported data at three months shows that the robot-assisted technique improved some short-term outcomes but resulted in longer OR time compared to open surgery. Reoperation during initial hospital stay was significantly more frequent in the open group after adjusting for tumour related factors and lymphnode dissection. PE08 Early and late complications after robot-assisted radical cystectomy with totally intracorporeal urinary diversion A. Hosseini, C. Adding, O. Laurin, P. Wiklund. Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden Introduction & Objectives: During the last years more centers performed radical cystectomy robotically. The aim of this report is to describe our results for early- and late complications after robotassisted radical cystectomy (RARC) with totally intracorporeal urinary diversion. Material & Methods: Between December 2003 and June 2013, a total of 164 bladder cancer patients (127 male, 37 female) underwent RARC with totally intracorporeal urinary diversion. Mean age was 64 years (range 37–87). Neoadjuvant Cisplatine-based chemotherapy was administrated in 33% of the patients. 29 patients (20%) had BCG treatment prior surgery. A total of 86 (52%) patients received a continent urinary diversion with intracorporeal neobladder formation and 78 (48%) an ileal conduit. Conversion to open surgery was necessary in 5 patients. Results: Patients with Ileal conduit had more frequent early complications with higher Median operating time was 382 minutes (range 177–760). On surgical pathology, 48% of patients had pT1 or less disease, 25% had pT2, and 27% had pT3/PT4 tumor. Patients who had neoadjuvant chemotherapy were found to have pT0 disease in 49%. The mean number of lymph nodes removed was 21 (range 0–60). 23% of patients had lymph node positive disease. Positive surgical margins occurred in 6 cases (3.6%). Median follow-up was 18 months (range 3–117 months). We recorded a total of 102 early complications (30 days) were recorded of which 22 patients (13%) had Clavien grade 3 or higher. Three patients (2%) died within 90 days after surgery, one from pulmonary embolism and two from cardiac arrest. Clavien grade than patients with neobladder; however, the difference was not statistically significant. Whereas patients with orthotopic neobladder had more late complications than the patients with ileal conduit (p<0.05). We found no relation between neoadjuvant treatment and history of BCG-treatment in relation to postoperative early and late complications. Conclusions: RARC with intracorporeal urinary diversion is a complex surgical procedure with post-operative morbidity. However the majority of complications are low grade (Clavian ≤2) and compari-
U N M O D E R A T E D P O S T E R P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
son with open cystectomy series will have to await further studies. A history of BCG- and neoadjuvant treatment in these patients was not associated with a higher complication rate. PE10 Open versus robotic nephron-sparing surgery: 4 year results and determinants of decision making O. Acar 1 , T. Esen 2 , M. Vural 3 , A. Musaoglu 1 . 1 VKF American Hospital, Dept. of Urology, Istanbul, Turkey; 2 Koc University, School of Medicine, Dept. of Urology, Istanbul, Turkey; 3 VKF American Hospital, Dept. of Radiology, Istanbul, Turkey Introduction & Objectives: Robotic technology has enabled a smooth transition from open to minimally invasive nephron-sparing surgery. Herein, we aimed to compare the outcomes of open and robot-assisted nephron-sparing surgeries performed within the robotic era of our institution. Material & Methods: After the installation of robotic hardware in our hospital, as of May 2010, a total of 64 open and 53 robotic NSSs have been carried out by a single surgeon. Charts were retrospectively reviewed in order to document the clinical characteristics, perioperative findings, postoperative outcome and investigate any relevant differences between the groups. Results: Mean patient age was 55.9±11.1 and 50.7±13.5 years in the open and robotic groups, respectively (p=0.026). Forty patients in each group were male. Mean ASA score was significantly higher in the open surgery group (1.6±0.7 vs. 1.4±0.5, respectively). Mean tumor size did not differ significantly between the study groups (4.1±1.9 vs. 3.4±2.5, p=0.085). However, patients in the open surgery group had more complicated tumors with higher mean R.E.N.A.L. score, mean P.A.D.U.A. score and lower c-index value. Mean operative time was 103.7±33 and 143.02±48.2 minutes in the open and robotic groups, respectively (p=0.0001). Estimated blood loss was insignificantly higher in the open group (184.4±126.2 vs. 180.9±149.3 ml, p=0.890). A total of 28 (43.7%) and 19 (35.8%) patients in the open and robotic groups respectively, were managed under warmischemic conditions and mean WIT was significantly higher in the robotic group (17.5±7.08 vs. 22.4±5.6 minutes, p=0.014). Length of hospitalization was significantly higher in the open surgery group (4.5±1.7 vs. 3.9±1.2 days, p=0.027). Mean postoperative eGFR was significantly lower than the mean preoperative eGFR in the open surgery group (74.5±18.6 vs. 83.8±20.4 ml/min/1.73 m2 , p=0.008) which was not the case for robotic NSS (83.3±17.2 vs. 89.5±16.8 ml/min/1.73 m2 , p=0.065). Eight patients in open and robotic groups, respectively suffered from a total of 18 and 13 clavien grade ≥2 complications in the perioperative period. Two patients in each group developed local recurrence after a mean duration of 22.2 months. Only one of these patients had an indeterminate surgical margin status while the 3 others had clear margins. One of them with additional systemic metastases was managed with targeted therapy and the other three underwent radical nephrectomy. None were lost due to a kidney-cancer related problem. Conclusions: More complicated kidney tumors, older and more problematic patients were handled via open NSS. Operative duration and warm-ischemia time were longer in the robotic surgery group whereas eGFR decline was higher in the open surgery group. Perioperative complications and oncologic outcome were similar between the groups during the follow-up period. PE11 Role of robotic radical prostatectomy in hormonal therapy for high-risk prostate cancer: A propensity score-adjusted analysis W.S. Ham, S.H. Lee, K.C. Koo. Yonsei University College of Medicine, Dept. of Urology and Urological Science Institute, Seoul, South Korea Introduction & Objectives: To evaluate the role of robotic radical
19
prostatectomy (RRP) in hormonal therapy (HT) for high-risk prostate cancer (PC). Material & Methods: We performed a propensity score–based analysis of 372 consecutive patients [group I (RRP with adjuvant HT): 209, group II (primary HT): 163] treated for high-risk PC. After adjusting for propensity scores, a Cox proportional hazard model (COX) was employed to test the influence of the respective treatment on postoperative hormone refractory PC (HRPC) progression, overall death and PC-specific death (PCSD). Results: Group II patients had an older age and more severe high-risk characteristics. During a median of 30.0 mo of follow-up, 9 men progressed into HRPC, 4 and 14 men died from PC and other causes in group I, vs. 23, 20 and 24 men, respectively, in group II. In group I, the 10-year HRPC progression-free survival rate was 87.0% and the 10-year overall survival rate and 10-year PC-specific survival rate were 71.3% and 95.2%, respectively, vs. 21.1%, 21.4% and 30.4%, respectively, in group II. There were significant differences between two groups with regards to the Kaplan-Meier estimates of these endpoints. After adjusting for the propensity to receive RRP with HT or primary HT, a regression analysis of survival based on COX revealed predictive influences of selection of treatment modality on these endpoints. Conclusions: RRP with adjuvant HT may prolong the time to HRPC progression, overall death and PCSD compared to primary HT. Therefore, RRP may have a significant role as a local therapy in treating high-risk patients. PE12 Robot-assisted retroperitoneal lymph node dissection for post-chemotherapy non-seminomatous germ cell tumor S.H. Jeon, D.S. Kim, S.H. Lee, S.-G. Chang. Kyung Hee University Hospital, Dept. of Urology, Seoul, South Korea Introduction & Objectives: The advancement in medical robot technology has allowed urologists the benefit of a wider selection of choices when choosing the right modality for laparoscopic surgery. We report here a case of robot assisted laparoscopic retroperitoneal lymph node dissection for post chemotherapy non-seminomatous germ cell tumor in Korea. Material & Methods: An 18-year-old-patient male was diagnosed with stage IIIb (T1N2M0S2, β-HCG 23,245.16 mIU/L, AFP 169.5 ng/ml, LD 644 U/L) mixed germ cell type testis cancer after radical orchiectomy of a left testicular mass and had undergone 3 cycles of BEP (bleomycis, etoposide, and cisiplatine) chemotherapy. Re-evaluation of the patient after chemotherapy showed normalization of tumor markers but remnant left para-aortic, aortocaval and right retrocrural lymph nodes. His parents were counseled for retroperitoneal lymph node dissection (RPLND) and offered robot retroperitoneal lymph node dissection (R-RPLND). They consented and left ipsilateral nerve saving R-RPLND using left modified template was partaken. Results: The patient had favorable body size for operation but was very slim due to chemotherapy (height 174.1 cm, weight 49.3 kg, BMI 16.3). He was put in a right lateral decubitus position and a 12 mm periumbilical camera port, three 8-mm robotic ports (one midline below the xyphoiod, the second midline above the pubis and the third medial to the left anterioir superior iliac spine) and two additional assistant ports (5 mm, 12 mm Rt upper and lower quadrants) were placed. First, the remnant right spermatic cord was dissected out and taken down to the point marked at previous orchiectomy. Next dissection was done inferiorly until the iliac crossing of the ureter was seen. Dissecting out the ureter allowed for proper retraction using the third Davinci arm to avoid ureteral injury was done. Lateral paraortic lymph nodes packages were dissected and visualization of the common iliac artery and aorta. Moderate left template was used; superiorly the renal hilum, inferiorly the iliac crossing of the ureter, lateraly the ureter and medially the lateral border of the aorta up until the inferior mesecteric artery level. Ultimately, the common iliac, pericaval,
U N M O D E R A T E D P O S T E R P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
the bladder neck – in case of 4 patients and pheochromocytoma with the lesion of the bladder – 1 patient. Criteria for an inclusion of patients: a non-multiple bladder cancer localized in the bladder neck with the level of invasion of the tumor within the muscle layer T2a–b, with the N0, G1–2 level of differentiation. Three robotic manipulators performed this operation with the use of bipolar clip, monopolar scissors, clip and needle holder. The first stage: cystoscopy and stenting of the ureters. The second stage: robot-assisted resection with transbladder light illumination. The third stage: pelvic lymphadenectomy. The defect of the rear wall was taken in by the thread V-Loc, 3-0 with the one- row continuous suture. Resection of the mouth of the ureter with the formation of mucoso-muscle cuff on the ureter-stent – 2 patients. Results: Median observations of patients ranged from 11 to 16 months (13.3 months). Recurrence of the tumor and metastases have not been revealed. Functional results in Table 1. Table 1. Results of the robotic treatment of the bladder cancer and pheochromocytoma with the lesion of the bladder Sex Age
f m m f m
Diagnosis
62 Pheochromocytoma of the bladder 65 Bladder cancer pT2aN0M0G2 69 Bladder cancer pT2bN0M0G2 67 Bladder cancer pT2bN0M0G2 57 Bladder cancer pT2aN0M0G2
Duration of Volume of Complications Duration of of the blood loss hospital stay operation (ml) (days) 2 h 30 min
50
none
10
2 h 40 min
80
none
8
3 h 20 min
100
none
9
2 h 15 min
60
none
12
2 h 30 min
100
none
7
Conclusions: Bladder sparing operations in the form of robotic resection of the bladder neck are the operations of choice for muscleinvasive bladder cancer and pheochromocytoma with the lesion of the bladder neck, which allow to remove radically the tumor, to resect the ureter with one-stage the formation of mucoso-muscle cuff on the ureter-stent, to perform the pelvic lymphadenectomy, and to preserve the urinary bladder in a large amount compared with the open resection and TUR of the bladder. PE07 Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open surgery A. Wallerstedt 1 , S. Tyritzis 1 , T. Thorsteinsdottir 2 , S. Carlsson 1 , J. Stranne 3 , O. Gustafsson 4 , J. Hugosson 3 , A. Bjartell 5 , U. Wilderäng 2 , P. Wiklund 1 , G. Steineck 2 , E. Haglind 6 . 1 Karolinska Institutet, Dept. of Molecular Medicine and Surgery, Section of Urology, Stockholm, Sweden; 2 Sahlgrenska Academy, Dept. of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Gothenburg, Sweden; 3 Sahlgrenska Academy, Dept. of Urology, Institute of Clinical Sciences, Gothenburg, Sweden; 4 Karolinska Institutet, Dept. of Molecular Department of Clinical Science, Intervention and Technology, Stockholm, Sweden; 5 Lund University, Dept. of Urology, Skåne University Hospital, Lund, Sweden; 6 Sahlgrenska Academy, Dept. of Surgery, Institute of Clinical Sciences, Gothenburg, Sweden Introduction & Objectives: Robot-assisted laparoscopic radical prostatectomy has become a widespread technique without randomized trials showing clear benefits in outcomes over open prostatectomy. The objective of this study was to evaluate patient-reported outcomes three months after surgery in robot-assisted laparoscopic compared to open retropubic radical prostatectomy. Material & Methods: Data derived from LAPPRO; a prospective controlled trial where data was collected with validated patient questionnaires and by health-care professionals from all men diagnosed with prostate cancer and planned for radical prostatectomy at 14 participating centers. Difference in outcome between the two treatment
groups were analyzed using logistic regression, with and without adjustment for possible confounders. Results: Questionnaires were received from 2517 (94%) patients. The robotic group had lower perioperative bleeding, P=<0.001, shorter time in recovery unit, P=0.05, and shorter hospital stay, P=<0.001. Operating time was shorter with the open technique, P=<0.001. Reoperation during initial hospital stay was more frequent after open surgery, after adjusting for tumour factors and lymph-node dissection, OR 0.31 (95% CI 0.11–0.90). Men operated with open technique were more likely to seek health-care, within 90 days after surgery, compared to men operated by the robotic technique, P=0.003. It was more common to seek health-care for cardiovascular reasons in the open group after adjusting for non-tumour and tumour-specific confounders, OR 0.63 (95% CI 0.42–0.94). Gastrointestinal and psychological reasons for seeking health care were more common in the open group but was affected by adjusting for non-tumour and tumour specific factors. The readmittence rate was not statistically different between the groups. A limitation of the study is the lack of a standardized tool for the assessment of the adverse events. Conclusions: Patient-reported data at three months shows that the robot-assisted technique improved some short-term outcomes but resulted in longer OR time compared to open surgery. Reoperation during initial hospital stay was significantly more frequent in the open group after adjusting for tumour related factors and lymphnode dissection. PE08 Early and late complications after robot-assisted radical cystectomy with totally intracorporeal urinary diversion A. Hosseini, C. Adding, O. Laurin, P. Wiklund. Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden Introduction & Objectives: During the last years more centers performed radical cystectomy robotically. The aim of this report is to describe our results for early- and late complications after robotassisted radical cystectomy (RARC) with totally intracorporeal urinary diversion. Material & Methods: Between December 2003 and June 2013, a total of 164 bladder cancer patients (127 male, 37 female) underwent RARC with totally intracorporeal urinary diversion. Mean age was 64 years (range 37–87). Neoadjuvant Cisplatine-based chemotherapy was administrated in 33% of the patients. 29 patients (20%) had BCG treatment prior surgery. A total of 86 (52%) patients received a continent urinary diversion with intracorporeal neobladder formation and 78 (48%) an ileal conduit. Conversion to open surgery was necessary in 5 patients. Results: Patients with Ileal conduit had more frequent early complications with higher Median operating time was 382 minutes (range 177–760). On surgical pathology, 48% of patients had pT1 or less disease, 25% had pT2, and 27% had pT3/PT4 tumor. Patients who had neoadjuvant chemotherapy were found to have pT0 disease in 49%. The mean number of lymph nodes removed was 21 (range 0–60). 23% of patients had lymph node positive disease. Positive surgical margins occurred in 6 cases (3.6%). Median follow-up was 18 months (range 3–117 months). We recorded a total of 102 early complications (30 days) were recorded of which 22 patients (13%) had Clavien grade 3 or higher. Three patients (2%) died within 90 days after surgery, one from pulmonary embolism and two from cardiac arrest. Clavien grade than patients with neobladder; however, the difference was not statistically significant. Whereas patients with orthotopic neobladder had more late complications than the patients with ileal conduit (p<0.05). We found no relation between neoadjuvant treatment and history of BCG-treatment in relation to postoperative early and late complications. Conclusions: RARC with intracorporeal urinary diversion is a complex surgical procedure with post-operative morbidity. However the majority of complications are low grade (Clavian ≤2) and compari-
U N M O D E R A T E D P O S T E R P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
son with open cystectomy series will have to await further studies. A history of BCG- and neoadjuvant treatment in these patients was not associated with a higher complication rate. PE10 Open versus robotic nephron-sparing surgery: 4 year results and determinants of decision making O. Acar 1 , T. Esen 2 , M. Vural 3 , A. Musaoglu 1 . 1 VKF American Hospital, Dept. of Urology, Istanbul, Turkey; 2 Koc University, School of Medicine, Dept. of Urology, Istanbul, Turkey; 3 VKF American Hospital, Dept. of Radiology, Istanbul, Turkey Introduction & Objectives: Robotic technology has enabled a smooth transition from open to minimally invasive nephron-sparing surgery. Herein, we aimed to compare the outcomes of open and robot-assisted nephron-sparing surgeries performed within the robotic era of our institution. Material & Methods: After the installation of robotic hardware in our hospital, as of May 2010, a total of 64 open and 53 robotic NSSs have been carried out by a single surgeon. Charts were retrospectively reviewed in order to document the clinical characteristics, perioperative findings, postoperative outcome and investigate any relevant differences between the groups. Results: Mean patient age was 55.9±11.1 and 50.7±13.5 years in the open and robotic groups, respectively (p=0.026). Forty patients in each group were male. Mean ASA score was significantly higher in the open surgery group (1.6±0.7 vs. 1.4±0.5, respectively). Mean tumor size did not differ significantly between the study groups (4.1±1.9 vs. 3.4±2.5, p=0.085). However, patients in the open surgery group had more complicated tumors with higher mean R.E.N.A.L. score, mean P.A.D.U.A. score and lower c-index value. Mean operative time was 103.7±33 and 143.02±48.2 minutes in the open and robotic groups, respectively (p=0.0001). Estimated blood loss was insignificantly higher in the open group (184.4±126.2 vs. 180.9±149.3 ml, p=0.890). A total of 28 (43.7%) and 19 (35.8%) patients in the open and robotic groups respectively, were managed under warmischemic conditions and mean WIT was significantly higher in the robotic group (17.5±7.08 vs. 22.4±5.6 minutes, p=0.014). Length of hospitalization was significantly higher in the open surgery group (4.5±1.7 vs. 3.9±1.2 days, p=0.027). Mean postoperative eGFR was significantly lower than the mean preoperative eGFR in the open surgery group (74.5±18.6 vs. 83.8±20.4 ml/min/1.73 m2 , p=0.008) which was not the case for robotic NSS (83.3±17.2 vs. 89.5±16.8 ml/min/1.73 m2 , p=0.065). Eight patients in open and robotic groups, respectively suffered from a total of 18 and 13 clavien grade ≥2 complications in the perioperative period. Two patients in each group developed local recurrence after a mean duration of 22.2 months. Only one of these patients had an indeterminate surgical margin status while the 3 others had clear margins. One of them with additional systemic metastases was managed with targeted therapy and the other three underwent radical nephrectomy. None were lost due to a kidney-cancer related problem. Conclusions: More complicated kidney tumors, older and more problematic patients were handled via open NSS. Operative duration and warm-ischemia time were longer in the robotic surgery group whereas eGFR decline was higher in the open surgery group. Perioperative complications and oncologic outcome were similar between the groups during the follow-up period. PE11 Role of robotic radical prostatectomy in hormonal therapy for high-risk prostate cancer: A propensity score-adjusted analysis W.S. Ham, S.H. Lee, K.C. Koo. Yonsei University College of Medicine, Dept. of Urology and Urological Science Institute, Seoul, South Korea Introduction & Objectives: To evaluate the role of robotic radical
19
prostatectomy (RRP) in hormonal therapy (HT) for high-risk prostate cancer (PC). Material & Methods: We performed a propensity score–based analysis of 372 consecutive patients [group I (RRP with adjuvant HT): 209, group II (primary HT): 163] treated for high-risk PC. After adjusting for propensity scores, a Cox proportional hazard model (COX) was employed to test the influence of the respective treatment on postoperative hormone refractory PC (HRPC) progression, overall death and PC-specific death (PCSD). Results: Group II patients had an older age and more severe high-risk characteristics. During a median of 30.0 mo of follow-up, 9 men progressed into HRPC, 4 and 14 men died from PC and other causes in group I, vs. 23, 20 and 24 men, respectively, in group II. In group I, the 10-year HRPC progression-free survival rate was 87.0% and the 10-year overall survival rate and 10-year PC-specific survival rate were 71.3% and 95.2%, respectively, vs. 21.1%, 21.4% and 30.4%, respectively, in group II. There were significant differences between two groups with regards to the Kaplan-Meier estimates of these endpoints. After adjusting for the propensity to receive RRP with HT or primary HT, a regression analysis of survival based on COX revealed predictive influences of selection of treatment modality on these endpoints. Conclusions: RRP with adjuvant HT may prolong the time to HRPC progression, overall death and PCSD compared to primary HT. Therefore, RRP may have a significant role as a local therapy in treating high-risk patients. PE12 Robot-assisted retroperitoneal lymph node dissection for post-chemotherapy non-seminomatous germ cell tumor S.H. Jeon, D.S. Kim, S.H. Lee, S.-G. Chang. Kyung Hee University Hospital, Dept. of Urology, Seoul, South Korea Introduction & Objectives: The advancement in medical robot technology has allowed urologists the benefit of a wider selection of choices when choosing the right modality for laparoscopic surgery. We report here a case of robot assisted laparoscopic retroperitoneal lymph node dissection for post chemotherapy non-seminomatous germ cell tumor in Korea. Material & Methods: An 18-year-old-patient male was diagnosed with stage IIIb (T1N2M0S2, β-HCG 23,245.16 mIU/L, AFP 169.5 ng/ml, LD 644 U/L) mixed germ cell type testis cancer after radical orchiectomy of a left testicular mass and had undergone 3 cycles of BEP (bleomycis, etoposide, and cisiplatine) chemotherapy. Re-evaluation of the patient after chemotherapy showed normalization of tumor markers but remnant left para-aortic, aortocaval and right retrocrural lymph nodes. His parents were counseled for retroperitoneal lymph node dissection (RPLND) and offered robot retroperitoneal lymph node dissection (R-RPLND). They consented and left ipsilateral nerve saving R-RPLND using left modified template was partaken. Results: The patient had favorable body size for operation but was very slim due to chemotherapy (height 174.1 cm, weight 49.3 kg, BMI 16.3). He was put in a right lateral decubitus position and a 12 mm periumbilical camera port, three 8-mm robotic ports (one midline below the xyphoiod, the second midline above the pubis and the third medial to the left anterioir superior iliac spine) and two additional assistant ports (5 mm, 12 mm Rt upper and lower quadrants) were placed. First, the remnant right spermatic cord was dissected out and taken down to the point marked at previous orchiectomy. Next dissection was done inferiorly until the iliac crossing of the ureter was seen. Dissecting out the ureter allowed for proper retraction using the third Davinci arm to avoid ureteral injury was done. Lateral paraortic lymph nodes packages were dissected and visualization of the common iliac artery and aorta. Moderate left template was used; superiorly the renal hilum, inferiorly the iliac crossing of the ureter, lateraly the ureter and medially the lateral border of the aorta up until the inferior mesecteric artery level. Ultimately, the common iliac, pericaval,