Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy

Abstract

BackgroundRobot-assisted radical prostatectomy (RARP) is performed by urologists as one of the surgical procedures for treating prostate cancer. Numerous studies have been published with regard to the impact of prostate weight on performing RARP but were limited by the insufficient number of patients and use of the transperitoneal approach. This study aimed to determine the effect of prostate gland weight on the surgical and short-term oncological outcomes of RARP using the extraperitoneal approach.MethodsIn total, 1168 patients who underwent extraperitoneal RARP (EP-RARP) performed by a single surgeon at Yonsei University Severance Hospital between May 2009 and May 2016 were included in the study. The patients were divided into 4 groups according to the prostate weight measured by transrectal ultrasonography preoperatively. Intraoperative and postoperative outcomes were analyzed retrospectively. One-way analysis of variance and the chi-square test were used in the statistical analyses.ResultsAge, the Gleason score, clinical stage, and pathological stage were significantly different. Patients with a larger prostate size had a longer console time and higher estimated blood loss (P < 0.05). There were no significant differences between the 4 groups in length of hospital stay, duration of catheterization, blood transfusion, body mass index, prostate-specific antigen (PSA) level, history of abdominal surgery, intraoperative complications, positive surgical margin, incidence of lymphocele, and PSA recurrence after 1 year.ConclusionsThe console time and estimated blood loss were significantly increased with a larger prostate size. However, there were no significant differences in the oncologic outcome and intraoperative complications, suggesting that EP-RARP requires meticulous bleeding control in patients with a prostate weighing > 75 g, and if appropriate management is implemented for blood loss intraoperatively, EP-RARP can be performed regardless of the prostate size.

Urinary diversion after pelvic exenteration for gynecologic malignancies

“…However, the benefit of the Wallace anastomosis remains unclear. Of note, single-center series reported higher rates of stricture with the Bricker method than with the Wallace techniques (25.3% vs 7.7%, respectively), 31 while a recent meta-analysis compared these two techniques and reported low and comparable risks of ureteroenteric stricture with the Bricker and the Wallace anastomosis (3% and 2%, respectively). 32 We prefer the Wallace I technique as it simplifies the ureteroileal anastomosis.…”

The association between prostate weight and positive surgical margins in prostate cancer: A meta‐analysis

“…And then, we eliminated 153 studies based on screening the titles and abstract. After full‐text assessing of 45 studies were performed, eventually 22 studies (Allaparthi, Hoang, Dhanani, & Tuerk, ; Butow et al, ; Caliskan, Kaba, Koca, & Ozturk, ; Chang, Moon, Gianduzzo, & Eden, ; Chu et al, ; Descazeaud, Zerbib, Vieillefond, Debre, & Peyromaure, ; Foley, Bott, Thomas, Parkinson, & Kirby, ; Freedland et al, ; Galfano et al, ; Goetzl, Krebill, Griebling, & Thrasher, ; Hong et al, ; Kim et al, ; Labanaris et al, ; Lallas et al, ; Levinson et al, ; Marchetti, Shikanov, Razmaria, Zagaja, & Shalhav, ; Msezane et al, ; Olsson et al, ; Pettus et al, ; Yadav et al, ; Yasui et al, ; Zorn et al, ) were enrolled in our meta‐analysis. The characteristics of them were introduced in Table .…”

Prediction of A Positive Surgical Margin and Biochemical Recurrence After Robot-Assisted Radical Prostatectomy&nbsp;

“…Kim et al determined that higher blood loss was associated with larger prostate size in a series of 1168 RARPs. Nevertheless, the nal PSM rate did not signi cantly differ among divided-size subgroups23 . Tamhankar et al reviewed 1406 RARPs to…”

“…PSM detected in radical prostatectomy (RP) specimens is considered a poor oncological outcome 6 ; however, its long-term effect on mortality remains uncertain 7 . Previous studies have reported several predictors for PSM, including prostate-speci c antigen (PSA) concentration, prostate weight 8 , obesity 9 , the histopathological ndings from biopsy and RP specimens 10 , surgeon experience 11 , pathologist interpretation 12 , surgical approach 13 , and surgical method [14][15][16][17] , may potentially in uence postoperative PSM. However, data from Asian countries regarding the prediction of PSM and BCR are still lacking owing to differences in PCa phenotypes between individuals in Asian and Western countries 18 .…”