50 Vs 50 A Comparison of the Oncologic Outcomes of Retropubic Prostatectomy and Robotic Prostatectomy Chris Ogden Tim Christmas Jordan Durrant Khalid A E Shendi Rene Woderich

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

Introduction Beginning on 1 st January 2007, the details of 50 consecutive Robotic Assisted Laparoscopic Prostatectomy cases were entered into a database and compared with the last 50 consecutive Radical Retropubic Prostatectomy cases. Beginning on 1 st January 2007, the details of 50 consecutive Robotic Assisted Laparoscopic Prostatectomy cases were entered into a database and compared with the last 50 consecutive Radical Retropubic Prostatectomy cases.

Methods Patient Data: Patient Data: Age Age Pre-Operative PSA, Staging, Gleason Score Pre-Operative PSA, Staging, Gleason Score Pre-Operative Haemoglobin Pre-Operative Haemoglobin Pre-Operative MRI Staging Pre-Operative MRI Staging

Methods Measured Outcomes were: Measured Outcomes were: Anaesthetic Time Anaesthetic Time Post-Operative Haemoglobin Post-Operative Haemoglobin Number of Nights in Hospital Number of Nights in Hospital Post-Operative Histopathology Post-Operative Histopathology Positive Margin Rate Positive Margin Rate

Methods All patients had 12 months follow-up with 3 monthly PSA checks. All patients had 12 months follow-up with 3 monthly PSA checks.

Surgical Technique Radical Retropubic Prostatectomy Radical Retropubic Prostatectomy Midline Vertical Skin Incision Midline Vertical Skin Incision Bladder Neck and Nerve Preserving Bladder Neck and Nerve Preserving Yates Drain Yates Drain Planned In-Patient Stay of 7-10 days, TWOC prior to discharge Planned In-Patient Stay of 7-10 days, TWOC prior to discharge

Surgical Technique Robot Assisted Laparoscopic Prostatectomy Robot Assisted Laparoscopic Prostatectomy 6 ports 6 ports Robinson’s drain for hours Robinson’s drain for hours Planned In-Patient Stay of 1-2 days Planned In-Patient Stay of 1-2 days TWOC as Out-Patient at 10 days TWOC as Out-Patient at 10 days

The Patient Groups Median Age Median Age Retropubic : 62 Retropubic : 62 Robotic : 61 Robotic : 61 Median PSA Median PSA Retropubic: 8.2 Retropubic: 8.2 Robotic: 7.1 Robotic: 7.1 Percentage with MRI T3 Staging Pre-Op Percentage with MRI T3 Staging Pre-Op Retropubic: 6% Retropubic: 6% Robotic: 8% Robotic: 8% 50 consecutive patients in each group. Non-randomised, no matching. 50 consecutive patients in each group. Non-randomised, no matching.

The Surgery Median Time Under Anaesthesia Median Time Under Anaesthesia Retropubic: 95 mins Retropubic: 95 mins Robotic: 270 mins Robotic: 270 mins Percentage Patients with Hb Drop > 4g/dL Percentage Patients with Hb Drop > 4g/dL Retropubic: 40% Retropubic: 40% Robotic: 12% Robotic: 12% Median Number of Post-Op Nights in Hospital Median Number of Post-Op Nights in Hospital Retropubic: 9 nights Retropubic: 9 nights Robotic: 2 nights Robotic: 2 nights

Reduction in Hospital Stay significant, un- paired T test shows p=< Reduction in Hospital Stay significant, un- paired T test shows p=<0.0001

Difference in blood loss significant, un- paired T test shows p= Difference in blood loss significant, un- paired T test shows p=0.0002

Oncologic Outcomes Stage > pT3 on Final Post-Op Histology Stage > pT3 on Final Post-Op Histology Retropubic: 32% Retropubic: 32% Robotic: 18% Robotic: 18% Positive Margin Rate in pT2 Tumours Positive Margin Rate in pT2 Tumours Retropubic: 24% Retropubic: 24% Robotic: 14% Robotic: 14%

12 Month Follow-Up Biochemical Recurrence in First 12 months Biochemical Recurrence in First 12 months Retropubic: 22% Retropubic: 22% Robotic: 4% Robotic: 4%

Conclusions The two groups are comparable, however, the lower PSA recurrence rate in Robotic Group is in part related to lower incidence of T3 tumours. The two groups are comparable, however, the lower PSA recurrence rate in Robotic Group is in part related to lower incidence of T3 tumours. There are early Oncologic advantages in making the transition to Robotic Prostatectomy. There are early Oncologic advantages in making the transition to Robotic Prostatectomy.

Conclusions The Robotic patients have a shorter hospital stay and less morbidity from blood loss. The Robotic patients have a shorter hospital stay and less morbidity from blood loss.

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

The Future PSA recurrence within 12 months confined to 7.6% of patients. PSA recurrence within 12 months confined 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.

The End Any questions? Any questions?