Long-term patient outcomes from the first year of a robotic surgery program using multi-surgeon implementation

Joshua Montroy, Ehab Elzayat, Chris Morash, Brian Blew, Luke T. Lavallée, Ilias Cagiannos, James Watterson, Jeffrey S. Oake, Michael FungKeeFung, Calvin Thompson, Robert Weber, Rodney H. Breau

Abstract


Introduction: There is concern that surgical quality initially declines during the learning phase of robotic surgery. At our institution, we used a multi-surgeon programmatic approach to the introduction of robotic surgery. The purpose of this study was to evaluate outcomes of patients treated during the first year of our program.

Methods: This is a historical cohort of all radical prostatectomy patients during a one-year period. Baseline, perioperative, and long-term followup data were prospectively and retrospectively collected. Treatment failure was a composite of any postoperative radiation, androgen-deprivation, or prostate-specific antigen (PSA) ≥0.2.

Results: During the study period, 225 radical prostatectomy procedures were performed (104 robotic and 121 open). Baseline characteristics were similar between groups (p>0.05). All patients were continent and 74% were potent prior to surgery. Mean estimated blood loss (280 cc vs. 760 cc; p<0.001) and blood transfusion (0% vs. 8.3%; p=0.002) was lower in the robotic cohort. Non-transfusion complications were similar between groups (13% vs. 12%; p=0.7). Mean hospital stay was shorter in the robotic cohort (1.4 vs. 2.5 days). There was no difference in overall positive margin rate (38% vs. 43%; p=0.4) or treatment failure at a median followup of 3.5 years (p=0.4). Robotically treated patients were more often continent (89% vs. 77%; p=0.02) and potent (48% vs. 32%; p=0.02).

Conclusions: Using an inclusive multi-surgeon approach, robotic prostatectomy was introduced safely at a Canadian academic institution.


Full Text:

EPUB (DRAFT)

References


Yaxley, J. W. et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet (London, England) 388, 1057–1066 (2016).

Canadian Agency for Drugs and Technologies in Health. The delivery of radical prostatectomy to treat men with prostate cancer. (2011).

Ahlering, T. E. et al. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 63, 819–22 (2004).

Farnham, S. B., Webster, T. M., Herrell, S. D. & Smith, J. A. Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology 67, 360–3 (2006).

Patel, V. R. & Sivaraman, A. Current status of robot-assisted radical prostatectomy: progress is inevitable. Oncology (Williston Park). 26, 616–9, 622 (2012).

Tewari, A., Srivasatava, A., Menon, M. & Members of the VIP Team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 92, 205–10 (2003).

Hu, J. C. et al. Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy. JAMA 302, 1557 (2009).

Lowrance, W. T. et al. Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J. Urol. 187, 2087–92 (2012).

Canadian Institute for Health Information (CIHI). Analysis in Brief The Delivery of Radical Prostatectomy to Treat Men With Prostate Cancer. (2014).

Dindo, D., Demartines, N. & Clavien, P.-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 240, 205–13 (2004).

Steers, W. D., LeBeau, S., Cardella, J. & Fulmer, B. Establishing a robotics program. Urol. Clin. North Am. 31, 773–780 (2004).

Carlsson, S. et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology 75, 1092–7 (2010).

Punnen, S. et al. How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int. 112, E314–E320 (2013).

Trinh, Q.-D. et al. Perioperative Outcomes of Robot-Assisted Radical Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample. Eur. Urol. 61, 679–685 (2012).

Tewari, A. et al. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur. Urol. 62, 1–15 (2012).

Ficarra, V. et al. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 104, 534–539 (2009).

Barton, M. K. No cost or safety advantage to robot-assisted radical prostatectomy compared with open-procedure surgery for patients with prostate cancer. CA. Cancer J. Clin. 64, 293–294 (2014).

Povolotskaya, N., Woolas, R. & Brinkmann, D. Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series. Int. J. Surg. Oncol. 2015, 814315 (2015).

Kwon, E. O. et al. Rapid implementation of a robot-assisted prostatectomy program in a large health maintenance organization setting. J. Endourol. 24, 461–5 (2010).

Carter-Brooks, C. M., Du, A. L., Bonidie, M. J. & Shepherd, J. P. The Impact of a Dedicated Robotic Team on Robotic-Assisted Sacrocolpopexy Outcomes. Female Pelvic Med. Reconstr. Surg. 1 (2017). doi:10.1097/SPV.0000000000000413

Luthringer, T., Aleksic, I., Caire, A. & Albala, D. M. Developing a successful robotics program. Curr. Opin. Urol. 22, 40–46 (2012).

Zorn, K. C. et al. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J. Urol. 182, 1126–32 (2009).




DOI: http://dx.doi.org/10.5489/cuaj.4528
 |  Add comment