Open Access

ARTICLE

Oncological and functional outcomes of a large Canadian robotic-assisted radical prostatectomy database with 10 years of surgical experience

Come Tholomier^1,2, Felix Couture^1,3, Khaled Ajib¹, Felix Preisser^4,5, Helen Davis Bondarenko¹, Cristina Negrean¹, Pierre Karakiewicz^1,4, Assaad El-Hakim⁶, Kevin C. Zorn¹

1 Department of Surgery, CHUM Section of Urology, Universite de Montreal, Montreal, Quebec, Canada
2 Division of Urology, McGill University Health Center, Montreal, Quebec, Canada
3 Department of Surgery, Division of Urology, Universite de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
4 Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
5 Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
6 Division of Robotic Urology, Hopital du Sacre-Coeur de Montreal, Quebec, Canada
Address correspondence to Dr. Kevin C. Zorn, 235 Rene Levesque East, Suite 301, Montreal, QC H2X1N8 Canada

Canadian Journal of Urology 2019, 26(4), 9843-9851.

Abstract

Introduction: Robotic-assisted radical prostatectomy (RARP) has grown to be the predominant global surgical approach to treat localized prostate cancer. However, there is still limited access to robotic technology and little data from Canadian cohorts. Herein, we report on our oncological and functional outcomes after 10 years of surgical experience.
Materials and methods: Prospective data from 1,034 RARP cases performed by two high-volume experienced surgeons at two academic centers were collected from October 2006 to June 2017. Preoperative characteristics, surgical, oncological, and functional outcomes were assessed up to 72 months postoperative.
Results: D’Amico risk distribution was 26.1%, 59.8%, and 14.1% for low, intermediate, and high-risk prostate cancer. Median (interquartile range) operative time, blood loss, and hospital stay were 170 minutes (145-200), 200 mL (150-300), and 1 day (1-1), respectively, and 1.4% received blood transfusion. Intraoperative complications occurred in 3.8%. Postoperatively, 32 (3.1%) and 138 (13.3%) men harbored major (Clavien III-IV) and minor complications (Clavien I-II), respectively. Among the 630 men (64.2%) with pT2 and 349 men (35.6%) with pT3 disease, stage-specific positive surgical margin rates were 15.7% and 39.0%, respectively. Urinary continence rates at 6, 12, and 72 months were 72.7%, 83.5%, and 84.9%, respectively. In men without preoperative erectile dysfunction, potency was observed in 45.6%, 59.4%, and 69.5% at 6, 12, and 72 months, respectively. Biochemical recurrence occurred in 105 patients (10.2%).
Conclusion: Mid-term oncological outcomes in two large Canadian centers demonstrate comparable results to non-Canadian centers of excellence. RARP appears to be safe with acceptable surgical, oncological, and functional outcomes in a publicly funded single-payer healthcare system.

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