Outcomes over 20 years performing robot-assisted laparoscopic prostatectomy: a single-surgeon experience

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robotic radical prostatectomy (RARP) has become a standard treatment for localized prostate cancer.
• Long-term outcomes and surgeon experience are crucial for evaluating the efficacy and safety of RARP.

Purpose of the Study:

• To assess the 20-year surgical experience of a single surgeon performing RARP.
• To analyze trends in oncologic control, functional outcomes, and complication rates over two decades.

Main Methods:

• Retrospective review of a prospectively maintained prostate cancer database.
• Analysis of 3,152 patients undergoing RARP by a single surgeon, divided into five-year cohorts (2001-2021).
• Evaluation of complication rates, continence, potency, and pathological staging.

Main Results:

• Complication rates (Clavien ≥3) decreased significantly from 5.9% to 3.2% (p=0.021).
• Significant stage and Gleason grade group migration towards more advanced disease was observed (p<0.001).
• One-year continence rates improved from 74.8% to 92.4% (p<0.001); potency outcomes remained stable for baseline potent patients.

Conclusions:

• Robotic radical prostatectomy demonstrates improved safety and functional outcomes with surgeon experience.
• Increased detection of advanced prostate cancer at the time of surgery necessitates ongoing evaluation of treatment strategies.
• Long-term single-surgeon data highlights the learning curve and evolving landscape of RARP.