The document compares the oncologic outcomes of 50 consecutive patients who underwent retropubic prostatectomy versus 50 consecutive patients who underwent robotic prostatectomy. Key findings include: - Robotic patients had significantly shorter hospital stays (median of 2 nights vs 9 nights) and less blood loss. - Robotic patients were less likely to have pathological upgrading to pT3 disease (18% vs 32%) and positive margins in pT2 tumors (14% vs 24%). - Biochemical recurrence rates at 12 months were lower in robotic patients (4% vs 22%). The conclusions are that the robotic approach provides early oncologic advantages along with reduced morbidity from shorter hospital stays and less blood loss. Larger long-term data

1. 5050 VsVs 5050
A Comparison of the OncologicA Comparison of the Oncologic
Outcomes of Retropubic ProstatectomyOutcomes of Retropubic Prostatectomy
and Robotic Prostatectomyand Robotic Prostatectomy
Chris Ogden
Tim Christmas
Jordan Durrant
Khalid A E Shendi
Rene Woderich

2. BackgroundBackground
 The Robotic Prostatectomy Program at The RoyalThe Robotic Prostatectomy Program at The Royal
Marsden began in late 2006 , led by Chris Ogden.Marsden began in late 2006 , led by Chris Ogden.
 Previously, Retropubic Prostatectomy wasPreviously, Retropubic Prostatectomy was
performed by Tim Christmas.performed by Tim Christmas.
 During this Transition period, a comparison of theDuring this Transition period, a comparison of the
two methods was made.two methods was made.
 Chris Ogden is now proctoring other InstitutionsChris Ogden is now proctoring other Institutions
making this transition.making this transition.

3. IntroductionIntroduction
 Beginning on 1Beginning on 1stst
January 2007, the details of 50January 2007, the details of 50
consecutive Robotic Assisted Laparoscopicconsecutive Robotic Assisted Laparoscopic
Prostatectomy cases were entered into aProstatectomy cases were entered into a
database and compared with the last 50database and compared with the last 50
consecutive Radical Retropubic Prostatectomyconsecutive Radical Retropubic Prostatectomy
cases.cases.

4. MethodsMethods
 Patient Data:Patient Data:
 AgeAge
 Pre-Operative PSA, Staging,Pre-Operative PSA, Staging,
Gleason ScoreGleason Score
 Pre-Operative HaemoglobinPre-Operative Haemoglobin
 Pre-Operative MRI StagingPre-Operative MRI Staging

5. MethodsMethods
 Measured OutcomesMeasured Outcomes
were:were:
 Anaesthetic TimeAnaesthetic Time
 Post-OperativePost-Operative
HaemoglobinHaemoglobin
 Number of Nights inNumber of Nights in
HospitalHospital
 Post-OperativePost-Operative
HistopathologyHistopathology
 Positive Margin RatePositive Margin Rate

6. MethodsMethods
 All patients had 12 monthsAll patients had 12 months
follow-up with 3 monthly PSAfollow-up with 3 monthly PSA
checks.checks.

7. Surgical TechniqueSurgical Technique
 Radical Retropubic ProstatectomyRadical Retropubic Prostatectomy
 Midline Vertical Skin IncisionMidline Vertical Skin Incision
 Bladder Neck and Nerve PreservingBladder Neck and Nerve Preserving
 Yates DrainYates Drain
 Planned In-Patient Stay of 7-10 days, TWOCPlanned In-Patient Stay of 7-10 days, TWOC
prior to dischargeprior to discharge

8. Surgical TechniqueSurgical Technique
 Robot AssistedRobot Assisted
LaparoscopicLaparoscopic
ProstatectomyProstatectomy
 6 ports6 ports
 Robinson’s drain for 12-24Robinson’s drain for 12-24
hourshours
 Planned In-Patient Stay ofPlanned In-Patient Stay of
1-2 days1-2 days
 TWOC as Out-Patient at 10TWOC as Out-Patient at 10
daysdays

9. The Patient GroupsThe Patient Groups
 Median AgeMedian Age
 RetropubicRetropubic : 62: 62
 RoboticRobotic : 61: 61
 Median PSAMedian PSA
 RetropubicRetropubic : 8.2: 8.2
 RoboticRobotic : 7.1: 7.1
 Percentage with MRI T3Percentage with MRI T3
Staging Pre-OpStaging Pre-Op
 RetropubicRetropubic : 6%: 6%
 RoboticRobotic : 8%: 8%
50 consecutive patients in each group. Non-randomised, no matching.50 consecutive patients in each group. Non-randomised, no matching.

10. The SurgeryThe Surgery
 Median Time UnderMedian Time Under
AnaesthesiaAnaesthesia
 RetropubicRetropubic : 95 mins: 95 mins
 RoboticRobotic : 270 mins: 270 mins
 Percentage Patients with HbPercentage Patients with Hb
DropDrop >> 4g/dL4g/dL
 RetropubicRetropubic : 40%: 40%
 RoboticRobotic : 12%: 12%
 Median Number of Post-OpMedian Number of Post-Op
Nights in HospitalNights in Hospital
 RetropubicRetropubic : 9 nights: 9 nights
 RoboticRobotic : 2 nights: 2 nights

11.  Reduction in Hospital Stay significant, un-Reduction in Hospital Stay significant, un-
paired T test shows p=<0.0001paired T test shows p=<0.0001
open
robotic
0
5
10
15
Mean ± SEM
p < 0.0001
Hospital Stay (nights)
Operative Group
MeanofHospitalStay(nights)

12.  Difference in blood loss significant, un-Difference in blood loss significant, un-
paired T test shows p=0.0002paired T test shows p=0.0002
open
robotic
0
1
2
3
4
5
Mean ± SEM
p < 0.0002
Hb Drop (gm/100mL)
Operative Group
HbDrop(gm/100mL)

13. Oncologic OutcomesOncologic Outcomes
 StageStage >> pT3 on FinalpT3 on Final
Post-Op HistologyPost-Op Histology
 RetropubicRetropubic : 32%: 32%
 RoboticRobotic : 18%: 18%
 Positive Margin RatePositive Margin Rate
in pT2 Tumoursin pT2 Tumours
 RetropubicRetropubic : 24%: 24%
 RoboticRobotic : 14%: 14%

14. 12 Month Follow-Up12 Month Follow-Up
 BiochemicalBiochemical
Recurrence in First 12Recurrence in First 12
monthsmonths
 RetropubicRetropubic : 22%: 22%
 RoboticRobotic : 4%: 4%

15. ConclusionsConclusions
 The two groups are comparable, however, theThe two groups are comparable, however, the
lower PSA recurrence rate in Robotic Group islower PSA recurrence rate in Robotic Group is
in part related to lower incidence of T3 tumours.in part related to lower incidence of T3 tumours.
 There are early OncologicThere are early Oncologic
advantages in making theadvantages in making the
transition to Robotictransition to Robotic
Prostatectomy.Prostatectomy.

16. ConclusionsConclusions
 The Robotic patients have a shorter hospital stayThe Robotic patients have a shorter hospital stay
and less morbidity from blood loss.and less morbidity from blood loss.

17. The FutureThe Future
 Our database now has over 200 cases,Our database now has over 200 cases,
we look forward to presenting this data awe look forward to presenting this data a
WRS.WRS.
 The data shows a consistent PositiveThe data shows a consistent Positive
Margin Rate of 14.7%.Margin Rate of 14.7%.
 27% of patients are discharged within 2427% of patients are discharged within 24
hours of surgery.hours of surgery.

18. The FutureThe Future
 PSA recurrence within 12 months confinedPSA recurrence within 12 months confined
to 7.6% of patients.to 7.6% of patients.
 85% of patients pad-free at 12 months.85% of patients pad-free at 12 months.
 Median console time of 145 minutes.Median console time of 145 minutes.

19. The EndThe End
 Any questions?Any questions?