Abstract
Objective
To evaluate a single surgeon’s 20-year experience with robotic radical prostatectomy.
Methods
Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001–2005; cohort B 2006–2010; cohort C 2011–2015; cohort D 2016–2021) for analysis. Oncologic and quality of life outcomes were recorded at the time of follow-up visits. Continence was defined as 0–1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks.
Results
Three thousand one hundred fifty-two patients met criteria for inclusion. Clavien ≥ 3 complication rates decreased from 5.9% to 3.2%, p = 0.021. There was considerable Gleason grade group (GG) and stage migration to more advanced disease between cohort A (6.4% GG4 or GG5, 16.2% pT3 or pT4, 1.2% N1) and cohort D (17% GG4 or GG5, 45.5% pT3 or pT4, 14.4% N1; p < 0.001). Consistent with this, an increasing proportion of patients required salvage treatments over time (14.6% of cohort A vs 22.5% of cohort D, p < 0.001). 1-year continence rates improved from 74.8% to greater than 92.4%, p < 0.001. While baseline potency and use of intraoperative nerve spare decreased, for patients potent at baseline, there were no significant differences for potency at one year (p = 0.065).
Conclusions
In this 20-year review of our experience with robotic prostatectomy, complication rates and continence outcomes improved over time, and there was a migration to more advanced disease at the time of surgery.
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Data availability
Data could be made available upon request to the corresponding author.
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No external funding was involved in the publication of this manuscript. Dr. Joseph Wagner serves as a consultant for Medtronic. The other authors have no relevant financial interests to disclose.
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Bandin, A., Staff, I., McLaughlin, T. et al. Outcomes over 20 years performing robot-assisted laparoscopic prostatectomy: a single-surgeon experience. World J Urol 41, 1047–1053 (2023). https://doi.org/10.1007/s00345-023-04346-7
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DOI: https://doi.org/10.1007/s00345-023-04346-7