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ECCLU 2011 - V. Ficarra - Prostate cancer: All the truth about local treatment options T1-T2 - Surgery
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ECCLU 2011 - V. Ficarra - Prostate cancer: All the truth about local treatment options T1-T2 - Surgery

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  • La robotica nel cronologia delle altre tecniche di prostatectomia radicale
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Up to now, we do not have CSS or OS data for RALP series. For this reason, …
  • Ma il dato più significativo nel contenimento dei costi è legato al volume operatorio settimanale. Il numero ideale sarebbe superiore a 6-7!!

ECCLU 2011 - V. Ficarra - Prostate cancer: All the truth about local treatment options T1-T2 - Surgery Presentation Transcript

  • 1. All the truth about local treatment options T1-2: surgery Vincenzo Ficarra Department of Oncological and Surgical Sciences Urologic Unit, University of Padova, Italy
  • 2. Radical Prostatectomy History 1904 1983 1992 2000 Non-anatomic Radical Prostatectomy (Young, 1904) Anatomic Retropubic Radical Prostatectomy (Walsh, 1983) Magnified Laparoscopic Radical Prostatectomy (Schuessler, 1992) Millimetric Robotic Radical Prostatectomy (Binder, 2000)
  • 3. Use of Minimally Invasive vs Open RP SEER registries: 2003-2007 Hu JC. et al. JAMA 2009; 302: 1557-1564
  • 4. 130 citations (2009-2011)
  • 5. MEDLINE [4,000 records] EMBASE [2,265 records] Web Science [4,219 records] 37 comparative studies non comparative studies Abstracts and reports from meeting of comparative studies Evidence acquisition: 1999-2008 Three Authors separately reviewed the records Studies cited in the references list
  • 6. Evidence from systematic review
    • LRP and RALP are followed by significantly
    • lower blood loss and transfusion rates and have
    • all traditional advantages of a minimally invasive
    • procedure
    • Data from this systematic review did not allow
    • us to prove the superiority of any surgical
    • approach in terms of functional and oncological
    • outcomes
  • 7. EAU Guidelines on Prostate Cancer www.uroweb.org Guidelines on Prostate Cancer – 2011
    • LRP and RALP were followed by a
    • significantly lower blood loss and
    • transfusion rate
    • It is still not clear which technique is superior in terms of oncological and functional results and cost-effectiveness
    • Prospective trials are urgently needed
  • 8. Update of the systematic review Novara G, Ficarra V, Montorsi F. et al. (Unpublished data)
  • 9. Update of the systematic review 37 comparative studies RRP Vs LRP (n = 23) RRP Vs RALP (n = 10) LRP Vs RALP (n = 4) RRP Vs LRP (n = 1) RRP Vs RALP (n = 16) LRP Vs RALP (n = 4) 21 comparative studies
  • 10. Outcomes evaluated
    • Perioperative
    • - blood loss, transfusion rate, overall complication
    • rates
    • Functional
    • - urinary continence and potency recovery
    • Oncological
    • - positive surgical margins, bDFS, OS and CSS
  • 11. Perioperative data: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
  • 12. Blood loss: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Most of the comparative studies reported data in a format not suitable for cumulative analysis (median values)
  • 13. Transfusion rate: RRP Vs RALP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
  • 14. Overall complications: RRP Vs RALP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
  • 15. Overall complication rate: RRP Vs RALP Carlsson S. et al. Urology 2010; 75: 1092-1099
  • 16. Outcomes evaluated
    • Perioperative
    • - blood loss, transfusion rate, overall complication
    • rates
    • Functional
    • - urinary continence and potency recovery
    • Oncological
    • - positive surgical margins, bDFS, OS and CSS
  • 17. Urinary continence recovery Myers R. J Urol 1987; 138 (3): 543-50
  • 18. Urinary continence recovery: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
  • 19. Urinary continence: RALP Vs RRP Tewari et al BJU Inter 2003; 92: 205-210. RALP RRP
  • 20. Urinary continence: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) 6-mo continence rate
  • 21. Urinary continence: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) 12-mo continence rate
  • 22. Nerve-sparing techniques and Potency recovery Stolzenburg JU et al, Eur Urol 2007;51(3):629-39 Interfascial Intrafascial
  • 23. Potency recovery: non comparative RALP series Ficarra V. et al. AUA Update series – Lesson 30; 2010
  • 24. Potency recovery: RALP Vs RRP Tewari et al BJU Inter 2003; 92: 205-210. RALP RRP
  • 25. Potency recovery: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
  • 26. Outcomes evaluated
    • Perioperative
    • - blood loss, transfusion rate, overall complication
    • rates
    • Functional
    • - urinary continence and potency recovery
    • Oncological
    • - positive surgical margins, bDFS, OS and CSS
  • 27. Positive Surgical Margin rates after RALP Ficarra V. et al. AUA Update series – Lesson 30; 2010
  • 28. Positive surgical margins: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data)
  • 29. Positive surgical margins: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Sensitivity analysis in prospective studies
  • 30. Positive surgical margins: RALP Vs RRP Novara G, Ficarra V., Montorsi F. et al (unpuplished data) Sensitivity analysis in pT2 prostate cancers
  • 31. Oncological Results: 5-year bDFS Menon M et al Eur Urol 2010; 58: 838-846 95% 91% 86% 81%
  • 32. Oncological Results: 5-year bDFS Mottrie A et al (submitted to BJU Inter) 81%
  • 33. Oncological Results: 3-year bDFS Schroeck FR et al BJU Inter 2008; 102: 28-32
  • 34. Oncological Results: 3-year bDFS Barocas DA et al J Urol 2010; 183: 990-996
  • 35. Oncological Results: 5-year bDFS Drouin SJ et al World J Urol 2009; 27: 599-605
  • 36. Potential disadvantages of minimally invasive radical prostatectomy: Costs Bolenz C. et al. Eur Urol 2010; 57: 453-458
  • 37. Conclusions
    • RALP is the main alternative to RRP in the
    • surgical treatment of localized prostate cancer
    • RALP showed significant advantages in terms of
    • perioperative outcomes in comparison with RRP
    • Data from the update of systematic review of the
    • Literature highlighted a significant advantage in
    • favour of RALP in terms of functional outcomes.
  • 38. Conclusions
    • Early and intermediate oncological outcomes
    • seems to be equivalent
    • Costs are the main disadvantages of RALP
    • It is likely that the selection of surgeon remains
    • one of the most critical factor influencing the
    • results