Robotic Radical Prostatectomy-Continence and Oncological Outcomes in 707 Cases

Goonewardene SS and Cahill D

The Royal Free and University College London, London,
Thomas Hospitals, London

^*Correspondance to: Goonewardene SS 

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Abstract:

Introduction: Robotic laparoscopic assisted radical prostatectomy is now considered the gold standard for localized prostate cancer. This patient group have high expectations with regards to oncological and functional outcomes, especially in the younger cohort.
Methods: A prospective database of 707 robotic radical laparoscopic prostatectomies (single centre, single surgeon, 2005-2015) was reviewed for primary outcomes of stage, oncological clearance and urinary continence. The results were reviewed for cohorts above and below 70 years of age.
Results: The mean age 60.2 years (range 42-75). The mean follow-up time was 4.5 years. 707 cases were reviewed. 670 patients were <70. Immediate continence occurred in 10%. Continence at 3 months was 78% and by 12 months was 93%. The average time to continence (pad free) was 11 weeks <70 years. 3 required slings. 314 men <70 were Gleason <3+4(47%), 356 Gleason >4+3(53.2%). 416 were T2 (positive margins 6.7%), 228 were T3 or above (positive margins 19.2%). Biochemical free recurrence rate (PSA <0.05 ng/ml) 94.4%.Overall positive margins were 10.7%. There were 37 patients >70 years. The mean time to continence was 18 weeks. Immediate continence occurred in 11%, by 3 months 65% were continent and at 12 months 89%. One patient required urethral dilation, none required slings. < Gleason 3+4 40.5%, > Gleason 4+3 59.5%. pT2 70.2% (positive margins 0%). pT3 29.7% (positive margins 4 cases, 36%). Biochemical free recurrence rate 86.5%. Overall positive margins 10.8%.
Discussion: This clearly demonstrates the role of robotic surgery in maintaining good urinary continence and oncological control. Age over 70 is not an issue if those men are well selected. Continence techniques evolve as part of the learning curve and continue to improve.

Keywords:

Robtic radical prostatectomy; Continence; Oncological outcomes

Cite the Article:

Goonewardene SS, Cahill D. Robotic Radical Prostatectomy-Continence and Oncological Outcomes in 707 Cases. Clin Oncol. 2016; 1: 1043.