Surgery News - November 2007 - (Page 13)

NOVEMBER 2007 • SURGERY NEWS UROLOGY 13 Large Prostatectomy Series Shows Few Complications BY ROBERT FINN High BMI Portends Poor Prostatectomy Outcomes S A N F R A N C I S C O — Robotic radical prostatectomy outcomes are worse for overweight or obese men than for men with normal body mass index values, according to a poster presentation by Dr. Jay D. Raman and colleagues at the annual meeting of the Society of Laparoendoscopic Surgeons. Dr. Raman of New York–Presbyterian Hospital, New York, and his colleagues studied 132 patients with clinically localized prostate cancer. They divided the patients into three cohorts, based on body mass index, in which 38 patients had a normal BMI (18-24.9 kg/m2), 60 were overweight (BMI 2529.9), and 34 were obese (BMI of 30 or greater). The groups had no significant preoperative differences in age, prostate-specific antigen level, or biopsy Gleason score. Obese patients had a significantly higher percentage of clinical T1c cancers (84%), than did overweight (67%) and normal-weight (55%) patients, but a significantly lower percentage of T2 cancers (16%), compared with overweight (31%) and normal-weight (45%) patients. The surgery took an average of 304 minutes in obese men, 235 minutes in overweight men, and 238 minutes in normalweight men. Blood loss averaged 234 mL in normal-weight men compared with 318 mL among overweight men and 316 mL in obese men. Hospitals stays averaged 1.1 days for men of normal weight, 1.6 days for overweight men, and 1.7 days for obese men. There were no significant differences among the groups in bilateral nerve-sparing (90% overall), open conversion (2% overall), and positive margins (17% overall). Complication rates were similar for all groups. —Robert Finn Else vier Global Medical Ne ws S A N F R A N C I S C O — Radical robotic prostatectomy had a complication rate of about 5.1% and promising medium-term outcomes, according to a large case series presented in two posters at the annual meeting of the Society of Laparoendoscopic Surgeons. This complication rate is similar to those reported in large series of open radical prostatectomies and lower than those reported in laparoscopic and other robotic series, wrote Dr. Pankaj P. Dangle and colleagues from The Ohio State University Medical Center, Columbus. According to the first poster, among 1,256 procedures performed by a single surgeon (Dr. Vipul R. Patel), there were 64 complications: 2 intraoperative, 16 perioperative, and 46 postoperative. No patients died and no patients had to be converted to open repair. One patient was converted to standard laparoscopy after a technical failure of the robot. Four patients had myocardial infarctions, four required blood transfusions, and three had pulmonary emboli. Anastomotic leakage occurred in 1.75% of the cases, partly because cystograms were performed on all patients. Given the low rates of urinary retention (0.33%) and contracture (0.13%), the investigators said the leakages were perhaps clinically insignificant. Most leakages occurred among the first 300 patients in the case series; only one occurred among the last 356 patients. The overall complication rate was 9.33% among the first 300 patients, versus 3.37% among the last 300. In the second poster, the investigators extended the case series to 1,500 patients, with all procedures performed by Dr. Patel over a 56-month period. As in the original series, he used the da Vinci Surgical System, and he performed the procedure transperitoneally using a six-trocar technique. The patients’ average age was 61, and their mean body mass index was 29 kg/m2. Their mean prostatespecific antigen was 8.65 ng/mL, and their mean Gleason score was 7. The operation took an average of 105 minutes, with a range 55-300 min. On average, patients lost 111 mL of blood, with a range of 50-500 mL. The prostates weighed a mean of 50 g with a range of 15-195 g. Dr. Patel performed a lymph node dissections in 128 (10.2%) of the patients, of which 19 (1.5%) had positive nodes. Overall, 11.6% of the patients had positive margins. Overall, 97% of the patients were discharged home on the first postoperative day. After 3 months, 92% of the patients were completely continent; that number went up to 97% after 6 months and 98% after 12 months. The investigators disclosed that they have no financial relationships related to their presentation. ■ CLASSIFIEDS Have questions on classifieds? Call Danny Wang (212) 633-3158 for more information. 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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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