Postoperative outcomes of robot-assisted laparoscopic radical prostatectomy from initial 100 cases at King Chulalongkorn Memorial Hospital

Abstract

Background : Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. Robot-assisted laparoscopic radical prostatectomy (RALP) is an evolving minimally invasive treatment for localized prostate cancer.

Objective : We analyzed the perioperative outcomes of RALP from our initial 100 cases experience.

Patients and Methods : From May 2011 to February 2015, 100 consecutive patients with clinical localized prostate cancer underwent RALP at our institution. All patients’ demographic data, postoperative parameters and pathological results were recorded and analyzed.

Results : The mean age of the patients was 64 (45 - 80) years; mean preoperative PSA was 14.1 ng/ml (2 - 75.4 ng/ml). Six patients had previous abdominal surgery and four patients had previous transurethral resection of the prostate. Mean operative time was 276 min (150 - 500). Mean estimated blood loss was 716 ml (100 - 3,000). The overall postoperative complication rate was 41% including 33% of transfusion. Two (2%) major complications, pelvic collection and ureteric injury with recto-vesicle fistula, were found. No mortality occurred in this study. There were 65 patients with pT2 disease, 34 patients with pT3 disease and 1 patient with pT4 disease. Overall positive surgical margin status was 43% (38.5% for pT2, 50% for pT3 and 100% for pT4). Only one patient (1%) had pelvic lymph node metastasis. Sixteen patients required adjuvant radiation or hormonal treatment. The mean catheterization time and mean postoperative hospital stay were 8.1 days.

Conclusions : RALP is a safe procedure carrying a low risk of complications even during the initial learning curve. Complications were mostly minor and could be managed conservatively. This confirms that RALP is a good treatment option for patients with clinical localized prostate cancer.