Outcomes of robotic prostatectomy for treating clinically advanced prostate cancer

Purpose: Robotic prostatectomy (RP) has been widely performed for treating clinically localized prostate cancer (PC), whereas for treating clinically advanced PC, prostatectomy is usually done by open methods. We evaluated the outcomes of RP for treating patients with clinically advanced PC as compared with the outcomes of RP for treating patients with clinically localized PC. Materials and Methods: We performed RP in 273 patients with the da Vinci® robot system through a transperitoneal approach. Ninety-two patients had clinically advanced PC (Group I) and 181 patients had clinically localized PC (Group II). We compared the perioperative variables and early surgical outcomes between the two groups. Results: The two groups did not show significant differences for their mean age, but the mean preoperative prostate-specific antigen (PSA) levels and biopsy Gleason scores were significantly higher in Group I. There were no significant differences in the mean operation time (Group I: 214.9±45.1 min, II 217.8±49.0 min, p=0.709), the estimated blood loss (Group 1: 382.8± 281.5ml, II: 387.5±369.5ml, p=0.934), the duration of bladder catheterization (Group I: 12.0±2.8 days, 11: 12.9±4.6 days, p=0.232), the hospital stay (Group I: 5.9±3.5 days, 11: 5.0±2.4 days, p=0.154), and the time to start the post-operative regular diet (Group 1: 25±1.5 days, II: 2.0±0.6 days, p=0.089) between the two groups. There was a significant difference in lymph node invasion (p<0.001), but no difference in the positive surgical margin (p= 0.180). Two out of the 4 intraoperative rectal injuries occurred in the clinically advanced PC group, but they were closed primarily without specific problems, except for 1 case. Conclusions: Our results suggest that RP may be performed safely for patients with clinically advanced PC.