Comparison between robot-assisted radical prostatectomy and minimum incision endoscopic radical prostatectomy for high-risk prostate cancer followi...

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Prostate Cancer
Surgical Oncology
Presenter Atsushi Imai
Citation Annals of Oncology (2018) 29 (suppl_9): ix67-ix73. 10.1093/annonc/mdy434
Authors A. Imai1, H. Yamamoto2, S. Hatakeyama2, T. Yoneyama2, Y. Hashimoto2, C. Ohyama2
  • 1Urology, Hirosaki University, 036-8562 - Hirosaki/JP
  • 2Urology, Hirosaki Univ. School of Med., 036-8560 - Hirosaki/JP

Abstract

Background

The treatment outcomes of robot-assisted radical prostatectomy (RARP) and minimum incision endoscopic radical prostatectomy (MIE-RP) for high-risk prostate cancer following preoperative endocrine chemotherapy were studied retrospectively.

Methods

In our department, RARP and MIE-RP were performed on 320 and 780 cases, respectively between 2004 and 2016. Of the total 1100 subjects, 232 (116 RARP; 116 MIE-RP) high risk prostate cancer patients underwent surgery after neoadjuvant therapy (ADT+low dose estramustine). Background factors were matched using propensity scores. Operation time, blood loss volume, Gleason score (GS), resection margin (RM), whether there was leakage from the anastomotic site, whether or not complications occurred and recurrence based on prostate specific antigen (PSA) levels were compared between the two groups. Selected background factors were age, PSA at the initial visit, clinical stage and biopsy GS. Neoadjuvant therapy was administered for at least for 6 months before surgery.

Results

The mean age of the patients was 67.2 years (47-78) and mean PSA at the initial visit was 17.1 ng/mL (4.2-95.6). In the RARP and MIE-RP groups, the mean operation times were 177 minutes (111-261) and 116 minutes (68-209), mean blood loss volumes 49 mL (1-300) and 1018 mL (50-2960), respectively, showing significant differences between the two groups (p < 0.001). Both the RM-positive rate (RARP: 1.7% and MIE-RP: 9.5%) and the PSA recurrence rate (RARP: 2.3% and MIE-RP: 15.5%) were significantly lower in the RARP group (p < 0.001).

Conclusions

As compared to MIE-RP, RARP for high-risk prostate cancer following preoperative endocrine chemotherapy was associated with longer surgical times, while the blood loss volume was significantly lower. Leakage from the anastomotic site and whether or not complications occurred did not differ between the two groups. Therefore, performing RARP with neoadjuvant therapy was considered to be safe. Furthermore, the RM-positive rate and the PSA recurrence rate were significantly lower, showing RARP to potentially play an important role as a highly radical surgery.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.