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Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy

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Abstract

Background

To assess the impact of preoperatively estimated prostate volume (PV) using transrectal ultrasonography (TRUS) on surgical and oncological outcomes in robot-assisted radical prostatectomy (RARP).

Methods

We analyzed the experience of a single surgeon at our hospital who performed 436 RARPs without neoadjuvant hormone therapy between August 2006 and December 2013. Patients were divided into three groups according to their preoperative PV calculated using TRUS (PV ≤ 20 cm3: group 1, n = 61; 20 < PV < 50 cm3: group 2, n = 303; PV ≥ 50 cm3: group 3, n = 72).

Results

Blood loss was significantly higher in group 3 than in group 1 and group 2. In stage pT2 patients, the rate of positive surgical margin (PSM) was significantly lower in group 3 than in group 1. In addition, perioperative complications significantly increased with increasing PV, while the extraprostatic extension (EPE) rate significantly decreased with increasing PV. The preoperative biopsy Gleason score, prostate-specific antigen (PSA) density, and clinical T2 stage were inversely correlated with increasing PV. Biochemical recurrence-free survival after RARP was significantly lower in group 1 than in groups 2 and 3.

Conclusions

A large prostate size was significantly associated with increased blood loss and a higher rate of perioperative complications. A small prostate size was associated with a higher PSM rate, PSA density, Gleason score, EPE rate, and biochemical recurrence rate. These results suggest that RARP was technically challenging in patients with large prostates, whereas small prostates were associated with unfavorable oncological outcomes.

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Acknowledgments

We wish to thank all study participants for their cooperation.

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Authors and Affiliations

  1. Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Yosuke Hirasawa, Yoshio Ohno, Jun Nakashima, Kenji Shimodaira, Takeshi Hashimoto, Tatsuo Gondo, Makoto Ohori & Masaaki Tachibana

  2. Department of Urology, Shin-Yurigaoka General Hospital, Furusawa Tsuko 255, Asaoku, Kawasaki, Kanagawa, Japan

    Kunihiko Yoshioka

Authors
  1. Yosuke Hirasawa
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  2. Yoshio Ohno
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  3. Jun Nakashima
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  4. Kenji Shimodaira
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  5. Takeshi Hashimoto
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  6. Tatsuo Gondo
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  7. Makoto Ohori
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  8. Masaaki Tachibana
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  9. Kunihiko Yoshioka
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Corresponding author

Correspondence to Jun Nakashima.

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Disclosures

Yosuke Hirasawa, Yoshio Ohno, Jun Nakashima, Kenji Shimodaira, Takeshi Hashimoto, Tatsuo Gondo, Makoto Ohori, Masaaki Tachibana, and Kunihiko Yoshioka have no conflicts of interest or financial ties to disclose.

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Hirasawa, Y., Ohno, Y., Nakashima, J. et al. Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy. Surg Endosc 30, 3702–3708 (2016). https://doi.org/10.1007/s00464-015-4664-1

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  • DOI: https://doi.org/10.1007/s00464-015-4664-1

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