Does prostate weight affect perioperative outcomes, positive surgical margin rates and functional outcomes after robot-assisted radical prostatectomy performed by an experienced surgeon?
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Data di Pubblicazione:
2011
Citazione:
Does prostate weight affect perioperative outcomes, positive surgical margin rates and functional outcomes after robot-assisted radical prostatectomy performed by an experienced surgeon? / P. Acquati, B. Rocco, G. Albo, A. Sivaraman, S. Chauhan, K.J. Palmer, R.F. Cohelo, V.R. Patel. ((Intervento presentato al 21. convegno Annual meeting of the Italian society of uro-oncology tenutosi a Napoli nel 2011.
Abstract:
Aim: To determine whether prostate weight has an impact on
pathological, perioperative and early functional outcomes after robot-assisted laparoscopic radical prostatectomy (RARP).
Patients and Methods:We analyzed 1,831 consecutive patients
who underwent RARP by a single surgeon. Patients were
stratified into three groups on the basis of pathological prostate
weight: group 1: <30 g, group 2: 30 to 49.9 g, group 3: 50 to
69.9 g and group 4: >70 g. Continence was defined as the use
of ‘no pads’. Potency was defined as the ability to achieve and
maintain adequate erections for penetration more than 50% of
the time with or without the use of PDE-5 inhibitors. Only
patients with preoperative SHIM score >21 and who
underwent bilateral nerve-sparing procedure were included in
the study. Groups were compared using one-way ANOVA on
ranks test and the Dunn’s method for multiple comparisons
when statistically significant differences were found. Results:
Patients with a larger prostate (group 4) were older (median
age 65 years), had higher pre-treatment PSA (median 5.8
ng/ml), higher AUA-SS (median 9), longer operative time
(median 80 min) and higher estimated blood loss (median 100
cc) (p<0.001 for all variables). There was no association
between prostate size and body mass index, biopsy Gleason
score, clinical stage, catheterization time, pathological stage,
hospital stay, anastomotic leak rates, specimen Gleason score
and continence rates (at one, three and six months). Overall
positive surgical margin rates were lower in patients with
prostate size larger than 70 g when compared to the other
groups (14.4% vs. 12.5% vs. 10.2% vs. 7.2%, respectively,
p<0.001). There was a trend towards lower potency rates in
patients with prostates larger than 70 g at four weeks (45.4%
vs. 35% vs. 32% vs. 25%, p=0.065) and three months (72%
vs. 75% vs. 75.2% vs. 65%, p=0.07) after RARP, although the
potency rates were similar among the groups at six months
after surgery. Conclusion: RARP performed by an experienced
surgeon in patients with an enlarged prostate is feasible, with
slightly higher operative time and estimated blood loss and
without any impact on early continence rates. There was a
trend towards lower early potency rates in patients with larger
prostates, which can probably be explained by the greater age
of these patients. Pathologically larger prostates were
associated with lower overall PSM rates even though the
pathological stage and specimen Gleason score were similar
in the groups.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
P. Acquati, B. Rocco, G. Albo, A. Sivaraman, S. Chauhan, K.J. Palmer, R.F. Cohelo, V.R. Patel
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