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- Sooriakumaran, P, et al.
(author)
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A meta-analysis comparing positive surgical margin and complication rates of 110,016 patients undergoing open retropubic, laparoscopic, and robotic-assisted radical prostatectomy
- 2011
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In: JOURNAL OF CLINICAL ONCOLOGY. - : American Society of Clinical Oncology (ASCO). - 0732-183X .- 1527-7755. ; 29:7
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Conference paper (other academic/artistic)abstract
- 103 Background: There is no clear evidence to support one form of surgical approach over another with regards radical prostatectomy. The aim of this study was to analyze the literature available between 2002 and 2008 and compare positive surgical margin and complication rates for open retropubic, laparoscopic, and robotic radical prostatectomy. Methods: A total of 110,016 patients formed the basis of this meta-analysis, representing the largest compilation of radical prostatectomy patients in the literature. Summary data were abstracted on year of publication, pre-operative patient characteristics, positive surgical margins, estimated blood loss, blood transfusions, conversions, length of hospital stay, and total intra- and peri-operative complications, with a further 21 individual perioperative complications selected a priori for abstraction and analysis. Results: The open and laparoscopic surgical groups had similar overall positive surgical margin rates, with the robotic group having lower rates. Both minimally invasive approaches showed significantly lower estimated blood loss and rate of blood transfusions, and a shorter length of hospital stay when compared to an open approach. A further decrease in these parameters was seen when robotic assistance was used. Total complication rates were highest for the open approach, intermediate for the laparoscopic cohort, and lowest for the robotic group. For the individual complication analysis, the rates for death, readmission, reoperation, ureteral, bladder, and rectal injury, ileus, pneumonia, fistula, and wound infection showed significant differences between groups. Conclusions: Robotic assisted laparoscopic radical prostatectomy has overall lower perioperative morbidity and improved early oncologic outcomes compared to conventional laparoscopic or open approaches. Further studies comparing longer term oncologic and functional outcomes, as well as cost-benefit comparisons are needed before making recommendations for or against a specific type of surgery. [Table: see text]
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- Sooriakumaran, P, et al.
(author)
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A multi-institutional study of 3,794 patients undergoing robotic-assisted laparoscopic radical prostatectomy to determine the surgical learning curve for positive margins and operating time
- 2011
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In: JOURNAL OF CLINICAL ONCOLOGY. - : American Society of Clinical Oncology (ASCO). - 0732-183X .- 1527-7755. ; 29:7
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Conference paper (other academic/artistic)abstract
- 102 Background: The surgical learning curve for robotic assisted laparoscopic radical prostatectomy (RALP) is often cited as being shorter than for other surgical modalities. However, while this appears true with regards to surgical safety, the learning curve for more refined variables like positive surgical margin (PSM) rate and operative time (OT) is not well established. Our objective was to assess the surgical learning curve for RALP in terms of these parameters. Methods: We performed a retrospective cohort study of 3,794 patients who underwent RALP between Jan 2003 and Sep 2009 by three surgeons (DL, PW, AKT) from three centers (UPenn, Karolinska, Cornell). Mean overall PSM rates and mean overall OT were calculated for all three surgeons at intervals of 50 RALPs per surgeon, and learning curves for these means were fit using a loess method. R version 2.71 was used for all statistical analysis. Results: The learning curve for PSM rates for all patients demonstrated improvements that continued with greater surgeon experience, with over 1,600 cases required to get a PSM rate <10%. When only pT3 patients were evaluated, the learning curve started to plateau after 1,000-1,500 cases. Mean OT plateaued after 750 cases although with further surgical experience the OTs started to climb again. Conclusions: The learning curve for RALP is not as short as previously thought, and a large number of cases are needed to get PSM rates and OTs to a minimum. This suggests that RALP should be performed by high volume surgeons in order to optimize patient outcomes. [Table: see text]
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- Sooriakumaran, P, et al.
(author)
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Authors' reply to Roach
- 2014
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In: BMJ (Clinical research ed.). - : BMJ. - 1756-1833. ; 348, s. g2271-
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Journal article (other academic/artistic)
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- Sooriakumaran, P, et al.
(author)
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Reply to Gianluca Giannarini, Nazareno Suardi and Alberto Briganti's letter to the editor re: Prasanna Sooriakumaran, Abhishek Srivastava, Shahrokh F. Shariat, et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22 393 open, laparoscopic, and robot-assisted radical prostatectomy patients. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2013.11.018
- 2014
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In: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 65:6, s. E91-E92
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Journal article (other academic/artistic)
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- Dev, HS, et al.
(author)
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Letter to the editor of IJS
- 2010
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In: International journal of surgery (London, England). - : Elsevier BV. - 1743-9159 .- 1743-9191. ; 8:5, s. 411-411
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Journal article (other academic/artistic)
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- Dev, HS, et al.
(author)
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Single-Site Surgery: More oR-LESS?
- 2010
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In: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 58:6, s. 849-850
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- Grover, S, et al.
(author)
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Clinicopathological strategies to identify contralateral prostate cancer involvement in potential candidates for focal therapy
- 2010
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In: International journal of surgical pathology. - : SAGE Publications. - 1940-2465 .- 1066-8969. ; 18:6, s. 499-507
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Journal article (peer-reviewed)abstract
- Objective: To identify the magnitude and possible predictors of contralateral lobe involvement and contralateral extraprostatic extension (EPE) in prostatic biopsy—defined localized unilateral cancers. Patients and Methods: Between January 2005 and August 2009, 1861 patients underwent robotic-assisted radical prostatectomy at the authors’ institution. A total of 1114 had unilateral disease on preoperative biopsy. Final histopathology reports of these patients were reviewed. Results: Of the 1114 patients with unilateral disease on biopsy, 867 (77.9%) had contralateral or bilateral disease on final histopathology. EPE was found in 132 patients (11.9%). Twenty patients (1.8%) had contralateral EPE involvement. High-grade prostatic intraepithelial neoplasm (HGPIN) on biopsy was the significant predictor of contralateral lobe involvement on both univariate ( P = .02; odds ratio [OR] = 1.791) and multivariate analysis ( P = .004; OR = 2.677). Clinical stage T2 was the significant predictor of contralateral EPE on both univariate ( P = .012; OR = 5.250) and multivariate analysis ( P = .007; OR = 8.656). Conclusion: HGPIN on biopsy significantly predicts for contralateral lobe involvement and should be considered an exclusion criterion for focal therapy in prostate cancer patients. Patients with palpable tumor on digital rectal examination should be advised in favor of radical treatment as these patients may harbor more aggressive tumors involving the contralateral side despite the biopsy findings.
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