Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies.

Abstract

BACKGROUND: Several robot-assisted radical prostatectomy (RARP) series have reviewed the impact of the initial learning curve on perioperative outcomes. However, little is known about the impact of experience on urinary and sexual outcomes. Herein, we review the perioperative, pathological and functional outcomes of our initial 700 consecutive procedures with at least 1 year follow up. METHODS: From 2003-2006, 700 consecutive men underwent RARP at a single, academic institution. Perioperative data and pathologic outcomes were prospectively collected. Validated, UCLA-PCI-SF36v2 quality-of-life questionnaires were also obtained at 1, 3, 6 and 12 months following surgery. Outcomes between groups (cases 1-300, 301-500, and 501-700) were compared. RESULTS: Mean operative time (OT) and blood loss significantly decreased during the experience (286, 198, 190 min; p <or= 0.001; 266, 190, 169 ml; p <or=0.001). Positive surgical margin (PSM) rate decreased in pT2 patients (15% versus 10% versus 7%; p = 0.03) despite operating on men with higher grade disease (biopsy GS>or=7 in 24%, 40%, 44%; p <or= 0.001). At 12 months postRARP, pad free continence rate was 81% when self reported and 62% when assessed by the UCLA-PCI-SF36v2 questionnaire in the initial group. Continence rates improved to 93% and 75%, respectively, for cases 501-700 (p <or= 0.05). Furthermore, significant improvement in continence rates between consecutive case groups was observed at all postoperative time points. Potency rate was 83% (bilateral nerve preservation) and 56% (unilateral nerve preservation) at 12 months when self reported and 63% and 37% respectively by the UCLA-PCI-SF36v2. No significant differences in sexual function were noted with increased experience. CONCLUSIONS: A prolonged learning curve is observed for EBL, OT and pT2-PSM. In addition, to the best of our knowledge, this is first series demonstrating a continued improvement in urinary continence with increased RARP experience.