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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Online ISSN 1827-1758
Jonas SCHIFFMANN 1, 2, Alexander HAESE 1, Katharina BOEHM 3, Georg SALOMON 1, Thomas STEUBER 1, Hans HEINZER 1, Hartwig HULAND 1, Markus GRAEFEN 1, Pierre I. KARAKIEWICZ 2, 4
1 Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; 2 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; 3 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 4 Department of Urology, University of Montreal Health Center, Montreal, Canada
BACKGROUND: Patients treated with robot-assisted radical prostatectomy (RARP) are frequently selected according to more favorable characteristics. Such patient selection might decrease according to increasing experience.
METHODS: We relied on the Martini-Clinic Prostate Cancer Center database and focused on patients treated with RARP between 2004 and 2013. Differences in clinical, pathological and surgical characteristics at RARP over time (2004-2010, 2011-2012 and 2013) were assessed.
RESULTS: Overall, 1,783 RARP patients were identified. Of those, 407 (22.8%), 764 (42.8%) and 612 (34.3%) were treated between 2004 and 2010, in 2011-2012 and in 2013, respectively. Unfavorable characteristics rate, such as biopsy Gleason score ≥4+4 (8 vs. 9 vs. 15%, p<0.001), D ́Amico high-risk (12 vs. 14 vs. 19%, p=0.001) and pathological Gleason score ≥4+4 (3 vs. 4 vs. 6%, p<0.001) increased over time. Pelvic lymph node dissection (PLND) was more frequently performed over time (62 vs. 83 vs. 84%, p<0.001), especially in D ́Amico intermediate or high-risk patients (82 vs. 94 vs. 96%, p<0.001). Lymph node yield increased over time in overall (7 vs. 9 vs. 13, p<0.001), D ́Amico intermediate (6 vs. 9 vs. 12, p<0.001) and D ́Amico high-risk patients (9 vs. 12 vs. 18, p<0.001). No differences in surgical margin (p=0.7) and nerve sparing rates (p=0.09) were found.
CONCLUSIONS: A clear trend towards more unfavorable tumor characteristics over time was recorded. Additionally, the rates and extent of PLND increased with increasing experience. RARP does not represent a barrier to PLND at our institution.