Robot-assisted radical prostatectomy in Hong Kong: a review of 235 cases

• Published in: Journal of endourology Vol. 26; no. 3; p. 258
• Main Authors: Yip, Kam Hung Sidney, Yee, Chi-hang, Ng, Chi-fai, Lam, Nga-Yee, Ho, Kwan-lun, Ma, Wai-kit, Li, Cheuk-man, Hou, See-ming, Tam, Po-Chor, Yiu, Ming-kwong, Fan, Cho-wai
• Format: Journal Article
• Language: English
• Published: United States 01.03.2012
• Subjects: Aged; Erectile Dysfunction - etiology; Hong Kong; Humans; Male; Multivariate Analysis; Perioperative Care; Prostate - surgery; Prostatectomy - adverse effects; Prostatectomy - methods; Robotics - methods; Treatment Outcome; Urinary Incontinence - etiology; Hong Kong
• ISSN: 1557-900X
• DOI: 10.1089/end.2011.0303

To report the outcome of all robot-assisted laparoscopic radical prostatectomy (RALP) in the public health care system in Hong Kong. All patients who underwent RALP in the public health care system with at least 1 year of follow-up were evaluated. Data analysis included age, body mass index, preoperative prostate-specific antigen (PSA) level, D'Amico risk category, operative details, pathologic stage, follow-up continence, potency, and biochemical recurrence. Between 2005 and 2009, 235 patients underwent RALP, with a mean age of 66.4±5.9 years and a mean preoperative PSA level of 11.0±10.5 ng/mL. Complications were 16 (7%) in total. There were 176 (74.9%) patients with pT(2) disease and 55 (23.4%) patients with pT(3) disease. The overall rate of positive surgical margins (PSM) was 20.7%. At postoperative 12 months, 72.5% of the patients were pad free. For those 83 preoperative potent patients having nerve-sparing surgery, the overall trifecta rate at 12 months was 37.3%. Multivariate analysis identified that pathologic T staging was significantly associated with PSM, with an odds ratio (OR) of 7.884 (95% confidence interval [CI]: 3.576-17.379; P<0.001) for the pT(3) group compared with the pT(2) group. When comparing D'Amico medium- and high-risk categories with low-risk categories, they were found to be significantly associated with biochemical failure (medium- compared with low-risk: OR=3.536, 95% CI: 1.253-10.173, P=0.016; high- compared with low-risk: OR=10.214, 95% CI: 2.958-35.274, P<0.001). Our data demonstrate the feasibility, safety, and efficacy of RALP in low-to-intermediate volume centers. Our early oncologic outcomes were significantly correlated with pathologic stage and D'Amico risk stratification.