Skip to main content
SpringerLink
Log in

Oncological outcomes following robotic-assisted radical prostatectomy in a multiracial Asian population

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

This study evaluates the oncological outcomes of RARP in a multiracial Asian population from a single institution. All suitable patients from 1st January 2003–30th June 2013 were identified from a prospectively maintained cancer registry. Peri-operative and oncological outcomes were analysed. Significance was defined as p < 0.05. There were n = 725 patients identified with a mean follow-up duration 28 months. The mean operative time, EBL and LOS were 186 min, 215 ml and 3 days, respectively. The pathological stage was pT2 in 68.6 % (n = 497/725), pT3 in 31.3 % (n = 227/725) and n = 1 patient with pT4 disease. The pathological Gleason scores (GS) were 6 in 27.9 % (n = 202/725), GS 7 in 63.6 % (n = 461/725) and GS ≥ 8 in 8.0 % (n = 58/725). The node positivity rate was 5.8 % (n = 21/360). The positive margin rates were 31.0 % (n = 154/497) and 70.9 % (n = 161/227) for pT2 and pT3, respectively, and decreasing PSM rates are observed with surgical maturity. The biochemical recurrence rates were 9.7 % (n = 48/497) and 34.2 % (n = 78/228) for pT2 and pT3/T4, respectively. On multivariate analysis, independent predictors of BCR were pathological T stage and pathological Gleason score. Post-operatively, 78.5 % (n = 569/725) of patients had no complications and 17.7 % (n = 128/725) had minor (Clavien grade I–II) complications. This series, representing the largest from Southeast Asia, suggests that RARP can be a safe and oncologically feasible treatment for localised prostate cancer in an institution with moderate workload.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP et al (2008) EAU guidelines on prostate cancer. Eur Urol 53(1):68–80

    Article  PubMed  Google Scholar 

  2. Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS et al (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177(6):2106–2131

    Article  PubMed  Google Scholar 

  3. Sim HG, Lim KH, Tay MH, Chong KT, Chiong E (2013) Guidelines on management of prostate cancer. Ann Acad Med Singapore 42(4):190–199

    PubMed  Google Scholar 

  4. Williams S, Chiong E, Lojanapiwat B, Umbas R, Akaza H (2013) Management of prostate cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 14(12):e524–e534

    Article  PubMed  Google Scholar 

  5. Sundram M (2010) Asian robotic experience. Urol Oncol 28(6):677–681

    Article  PubMed  Google Scholar 

  6. Sim HG, Yip SK, Lau WK, Tan JK, Cheng CW (2004) Early experience with robot-assisted laparoscopic radical prostatectomy. Asian J Surg 27(4):321–325

    Article  PubMed  Google Scholar 

  7. Yip KH, Yee CH, Ng CF, Lam NY, Ho KL, Ma WK et al (2012) Robot-assisted radical prostatectomy in Hong Kong: a review of 235 cases. J Endourol 26(3):258–263

    Article  PubMed  Google Scholar 

  8. Kim KH, Lim SK, Shin TY, Chung BH, Hong SJ, Rha KH (2013) Biochemical outcomes after robot-assisted radical prostatectomy in patients with follow-up more than 5-years. Asian J Androl 15(3):404–408

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Hashimoto T, Yoshioka K, Gondo T, Kamoda N, Satake N, Ozu C et al (2013) Learning curve and perioperative outcomes of robot-assisted radical prostatectomy in 200 initial Japanese cases by a single surgeon. J Endourol 27(10):1218–1223

    Article  PubMed  Google Scholar 

  10. Ou YC, Yang CK, Chang KS, Wang J, Hung SW, Tung MC et al (2014) The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China. Asian J Androl 16(5):728–734

    Article  PubMed Central  PubMed  Google Scholar 

  11. Menon M, Bhandari M, Gupta N, Lane Z, Peabody JO, Rogers CG et al (2010) Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. Eur Urol 58(6):838–846

    Article  PubMed  Google Scholar 

  12. Sooriakumaran P, Haendler L, Nyberg T, Gronberg H, Nilsson A, Carlsson S et al (2012) Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum follow-up time of 5 years. Eur Urol 62(5):768–774

    Article  PubMed  Google Scholar 

  13. Suardi N, Ficarra V, Willemsen P, De Wil P, Gallina A, De Naeyer G et al (2012) Long-term biochemical recurrence rates after robot-assisted radical prostatectomy: analysis of a single-center series of patients with a minimum follow-up of 5 years. Urology 79(1):133–138

    Article  PubMed  Google Scholar 

  14. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655

    Article  CAS  PubMed  Google Scholar 

  15. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474

    Article  PubMed  Google Scholar 

  16. D’Amico AV, Whittington R, Malkowicz SB, Fondurulia J, Chen MH, Tomaszewski JE et al (1998) The combination of preoperative prostate specific antigen and postoperative pathological findings to predict prostate specific antigen outcome in clinically localized prostate cancer. J Urol 160(6 Pt 1):2096–2101

    Article  PubMed  Google Scholar 

  17. Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR et al (2007) Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 177(2):540–545

    Article  CAS  PubMed  Google Scholar 

  18. Samaratunga H, Montironi R, True L, Epstein JI, Griffiths DF, Humphrey PA et al (2011) International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 1: specimen handling. Mod Pathol 24(1):6–15

    Article  PubMed  Google Scholar 

  19. Hashimoto T, Yoshioka K, Nagao G, Nakagami Y, Ohno Y, Horiguchi Y, Namiki K, Nakashima J, Tachibana M (2014) Prediction of biochemical recurrence after robot-assisted radical prostatectomy: analysis of 784 Japanese patients. Int J Urol 22(2):188–193. doi:10.1111/iju.12624

    Article  PubMed  Google Scholar 

  20. Xylinas E, Durand X, Ploussard G, Campeggi A, Allory Y, Vordos D et al (2013) Evaluation of combined oncologic and functional outcomes after robotic-assisted laparoscopic extraperitoneal radical prostatectomy: trifecta rate of achieving continence, potency and cancer control. Urol Oncol 31(1):99–103

    Article  PubMed  Google Scholar 

  21. Novara G, Ficarra V, D’Elia C, Secco S, Cavalleri S, Artibani W (2011) Trifecta outcomes after robot-assisted laparoscopic radical prostatectomy. BJU Int 107(1):100–104

    Article  PubMed  Google Scholar 

  22. Shikanov SA, Zorn KC, Zagaja GP, Shalhav AL (2009) Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology 74(3):619–623

    Article  PubMed  Google Scholar 

  23. Jayram G, Decastro GJ, Large MC, Razmaria A, Zagaja GP, Shalhav AL et al (2011) Robotic radical prostatectomy in patients with high-risk disease: a review of short-term outcomes from a high-volume center. J Endourol 25(3):455–457

    Article  PubMed  Google Scholar 

  24. Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R (2006) Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol 49(5):866–71 (discussion 871–2)

  25. Sooriakumaran P, John M, Wiklund P, Lee D, Nilsson A, Tewari AK (2011) Learning curve for robotic assisted laparoscopic prostatectomy: a multi-institutional study of 3794 patients. Minerva Urol Nefrol 63(3):191–198

    CAS  PubMed  Google Scholar 

  26. Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA et al (2012) Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 62(3):431–452

    Article  PubMed  Google Scholar 

  27. Sooriakumaran P, Srivastava A, Shariat SF, Stricker PD, Ahlering T, Eden CG et al (2014) A multinational, multi-institutional study comparing positive surgical margin rates among 22,393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol 66(3):450–456

    Article  PubMed  Google Scholar 

  28. Eastham JA, Kuroiwa K, Ohori M, Serio AM, Gorbonos A, Maru N et al (2007) Prognostic significance of location of positive margins in radical prostatectomy specimens. Urology 70(5):965–969

    Article  PubMed  Google Scholar 

  29. Ochiai A, Sotelo T, Troncoso P, Bhadkamkar V, Babaian RJ (2008) Natural history of biochemical progression after radical prostatectomy based on length of a positive margin. Urology 71(2):308–312

    Article  PubMed  Google Scholar 

  30. Swindle P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N et al (2008) Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 179(5 Suppl):S47–S51

    Article  PubMed  Google Scholar 

  31. Mauermann J, Fradet V, Lacombe L, Dujardin T, Tiguert R, Tetu B et al (2013) The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients. Eur Urol 64(1):19–25

    Article  PubMed  Google Scholar 

  32. Udo K, Cronin AM, Carlino LJ, Savage CJ, Maschino AC, Al-Ahmadie HA et al (2013) Prognostic impact of subclassification of radical prostatectomy positive margins by linear extent and Gleason grade. J Urol 189(4):1302–1307

    Article  PubMed  Google Scholar 

  33. Kumar R, Nayyar R, Kumar V, Gupta NP, Hemal AK, Jagannathan NR et al (2008) Potential of magnetic resonance spectroscopic imaging in predicting absence of prostate cancer in men with serum prostate-specific antigen between 4 and 10 ng/ml: a follow-up study. Urology 72(4):859–863

    Article  PubMed  Google Scholar 

  34. Vilanova JC, Barcelo-Vidal C, Comet J, Boada M, Barcelo J, Ferrer J et al (2011) Usefulness of prebiopsy multifunctional and morphologic MRI combined with free-to-total prostate-specific antigen ratio in the detection of prostate cancer. AJR Am J Roentgenol 196(6):W715–W722

    Article  PubMed  Google Scholar 

  35. Numao N, Yoshida S, Komai Y, Ishii C, Kagawa M, Kijima T et al (2013) Usefulness of pre-biopsy multiparametric magnetic resonance imaging and clinical variables to reduce initial prostate biopsy in men with suspected clinically localized prostate cancer. J Urol 190(2):502–508

    Article  PubMed  Google Scholar 

  36. Lim GH, Chow KY, Lee HP (2012) Singapore cancer trends in the last decade. Singapore Med J 53(1):3–9 (quiz 10)

  37. Hwii Ko Y, Jae Sung D, Gu Kang S, Ho Kang S, Gu Lee J, Jong Kim J et al (2011) The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score. Asian J Androl 13(3):487–493

    Article  PubMed Central  PubMed  Google Scholar 

  38. Somford DM, Hamoen EH, Futterer JJ, van Basten JP, Hulsbergen-van de Kaa CA, Vreuls W et al (2013) The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. J Urol 190(5):1728–1734

    Article  CAS  PubMed  Google Scholar 

  39. Tamada T, Sone T, Jo Y, Yamamoto A, Ito K (2014) Diffusion-weighted MRI and its role in prostate cancer. NMR Biomed 27(1):25–38

    Article  PubMed  Google Scholar 

  40. Verma S, Turkbey B, Muradyan N, Rajesh A, Cornud F, Haider MA et al (2012) Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. AJR Am J Roentgenol 198(6):1277–1288

    Article  PubMed  Google Scholar 

  41. Kim CK, Park BK, Kim B (2010) Diffusion-weighted MRI at 3 T for the evaluation of prostate cancer. AJR Am J Roentgenol 194(6):1461–1469

    Article  PubMed  Google Scholar 

  42. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22(4):746–757

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

This study had approval of the institutional research ethics board (CIRB 2009/743/D) and all procedures were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Author information

Authors and Affiliations

  1. Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore

    Low Wei Xiang Alvin, Sim Hong Gee, Huang Hong Hong, Cheng Wai Sam Christopher, Ho Sien Sun Henry, Lau Kam On Weber & Lee Lui Shiong

  2. Department of Pathology, Singapore General Hospital, Singapore, 169856, Singapore

    Tan Puay Hoon

Authors
  1. Low Wei Xiang Alvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sim Hong Gee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huang Hong Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng Wai Sam Christopher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ho Sien Sun Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lau Kam On Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tan Puay Hoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lee Lui Shiong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Low Wei Xiang Alvin.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alvin, L.W.X., Gee, S.H., Hong, H.H. et al. Oncological outcomes following robotic-assisted radical prostatectomy in a multiracial Asian population. J Robotic Surg 9, 201–209 (2015). https://doi.org/10.1007/s11701-015-0516-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-015-0516-1

Keywords

Search

Navigation