Complications following robot-assisted radical prostatectomy in a prospective Canadian cohort of 305 consecutive cases

Abstract

Background: Robot-assisted radical prostatectomy (RARP) has emerged in the last decade as an alternative to open radical prostatectomy for men with localized prostate cancer. The increased cost of this technique has been justified by its ability to reduce blood loss, and to provide improved vision, less postoperative pain and more rapid recovery from surgery, while maintaining satisfactory oncological and functional outcomes. Given the increasing diffusion of robotic surgical technology within Canada and its associated high capital and operating costs, we review the clinical outcomes and complications from 305 consecutive cases performed at our Canadian institution. Methods: A consecutive cohort of 305 patients with a mean followup of 30 months was analyzed with institutional ethics approval. All patients were treated and reviewed postoperatively by a single surgeon (SP). The primary aim of the study was to assess the incidence and type of complications associated with RARP in a Canadian setting. Our prospective database captured preoperative, intra-operative and postoperative data and was maintained by an individual independent of the robotic program. We report complications categorized according to the Clavien system. Multiple complications seen in an individual were recorded separately for the purposes of our analysis. Results: Between April 2005 and October 2010, 305 patients underwent RARP at our institution. A total of 70 complications were identified, with 47 (67.1%) requiring only conservative or pharmacological management (Clavien I-II). Twenty-three patients were found to have a major complication (Clavien III-V). Of the 16 who required intervention under general anesthesia, 3 required emergency treatment and the remaining patients underwent elective surgery. Conclusions: RARP has been incorporated at our institution with an acceptably low rate of intra-operative and postoperative complications. We have found that the database was effective in providing patients with outcome-related information, which in turn helped us gain patient consent with regard to the institution-specific risks of RARP.

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

“…Fuller and Pautler recorded 70 complications in 350 RARP cases: 7.5% major, 15.4% minor and overall 5.2% required further intervention. 8 Our mean hospital stay of 1.2 days matches large RARP series in the United States, but was significantly lower than in a reported Canadian series of LRP (3.4 days) 17 and RARP (3 days). 8 Overall the PSM rate was 30%, subdivided into 25.7% for pT2 and 43.3% for pT3 disease.…”

“…23 Fuller and Pautler reported an overall PSM rate of 16.1% in their cohort of low-to intermediate-risk RARP, with 10.2% for pT2 and 32% for pT3. 8 In Ontario, the median provincewide PSM rate for pT2 disease was 33% among 43 hospitals, with RRP volumes ranging 12 to 625, with no differences between community and teaching hospitals. 23 The University of Toronto group reported an overall 20.8% PSM in 1268 men who underwent RRP between 1992 and 2008.…”

“…Fuller and Pautler reported a 70% no-pad use at 1 year. 8 The University of Alberta group reported continence rates post-RRP of 57% at 3 months, and 85% at 12 months (definition of incontinence, <8 g of urine loss on the pad test per day). 12 In another prospective study from the same group, 239 patients were studied (172 RRP and 67 LRP).…”

“…7 The only published RARP series is by Fuller and Pautler on 305 patients. 8 Therefore, the purpose of this study is to expand the Canadian robotic prostatectomy literature by reporting a single surgeon experience of RARP with complete accounts of functional and oncological outcomes, along with complications and learning curve. …”

Robotic surgery improves transfusion rate and perioperative outcomes using a broad implementation process and multiple surgeon learning curves

“…Some Canadian studies were included but given little weight in decision making due to study limitations. 2,[4][5][6][7][8] A plethora of Canadian administrative data is available for patients receiving prostatectomy, however, these data were not incorporated in the HQO analyses as they are not published. 2 Given the lack of real world Canadian data on this topic, we sought to review all cases of open and robotic prostatectomies at our institution.…”