Oncological and functional outcomes of a large Canadian robotic-assisted radical prostatectomy database with 10 years of surgical experience.

Abstract

Robotic-assisted radical prostatectomy (RARP) has grown to be the predominant global surgical approach to treat localized prostate cancer. However, there is still limited access to robotic technology and little data from Canadian cohorts. Herein, we report on our oncological and functional outcomes after 10 years of surgical experience.Prospective data from 1,034 RARP cases performed by two high-volume experienced surgeons at two academic centers were collected from October 2006 to June 2017. Preoperative characteristics, surgical, oncological and functional outcomes were assessed up to 72 months postoperative.D'Amico risk distribution was 26.1%, 59.8% and 14.1% for low, intermediate and high risk prostate cancer. Median (interquartile range) operative time, blood loss and hospital stay were 170 minutes (145-200), 200 mL (150-300) and 1day (1-1), respectively and 1.4% received blood transfusion. Intraoperative complications occurred in 3.8%. Postoperatively, 32 (3.1%) and 138 (13.3%) men harbored major (Clavien III-IV) and minor complications (Clavien I-II), respectively. Among the 630 men (64.2%) with pT2 and 349 men (35.6%) with pT3 disease, stage-specific positive surgical margin rates were 15.7% and 39.0%, respectively. Urinary continence rates at 6, 12 and 72 months were 72.7%, 83.5% and 84.9%, respectively. In men without preoperative erectile dysfunction, potency was observed in 45.6%, 59.4% and 69.5% at 6, 12 and 72 months, respectively. Biochemical recurrence occurred in 105 patients (10.2%).Mid-term oncological outcomes in two large Canadian centers demonstrate comparable results to non-Canadian centers of excellence. RARP appears to be safe with acceptable surgical, oncological and functional outcomes in a publicly funded single-payer healthcare system.