Abstract
BACKGROUND
Roboticโassisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. Only a few large series have been published to date, with few longโterm data available. The current study presents what to the authors' knowledge is the largest series of patients undergoing RAP with the longest followโup to data available to date. Using a continuous quality improvement initiative, several technical refinements were adopted, evaluating the impact of this on patient outcome.
METHODS
Over a 6โyear period, 2766 consecutive men underwent RAP at the study institution. Data were collected prospectively including demographic, surgical, oncologic, and functional outcomes with up to 5โyear followโup. The first 200 and most recent 200 patients were compared to determine the impact of experience and quality improvement for patients.
RESULTS
The mean age of the patients was 60.2 years and the mean prostateโspecific antigen (PSA) level at time of diagnosis was 6.43 ng/mL; 42.4% and 64.2% of patients, respectively, had a biopsy and pathologic Gleason sum of โฅ7. The mean surgical and console time was 154 minutes and 116 minutes, respectively. Estimated blood loss was 100 mL; 96.7% of patients were discharged within 24 hours of surgery. At a median followโup of 22 months, 7.3% of men had a PSA recurrence. The 5โyear actuarial biochemical free survival rate was 84%.
CONCLUSIONS
To the authors' knowledge, the current study is the first report of 5โyear outcomes in men undergoing RAP. These data demonstrate that RAP can be performed with favorable outcomes while minimizing complications. As experience increases, further improvements in clinicopathologic and functional parameters are achieved. Cancer 2007;110:1951โ8. ยฉ 2007 American Cancer Society.