Best Practices in Robot-assisted Radical Prostatectomy: Recommendations of the Pasadena Consensus Panel Article

Industry Collaboration International Collaboration

cited authors

  • Montorsi, Francesco, Wilson, Timothy G., Rosen, Raymond C., Ahlering, Thomas E., Artibani, Walter, Carroll, Peter R., Costello, Anthony, Eastham, James A., Ficarra, Vincenzo, Guazzoni, Giorgio, Menon, Mani, Novara, Giacomo, Patel, Vipul R., Stolzenburg, Jens-Uwe, Van der Poel, Henk, Van Poppel, Hein, Mottrie, Alexandre

funding text

  • Francesco Montorsi certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Francesco Montorsi, Giorgio Guazzoni, and Alexandre Mottrie acknowledge receiving research grants from Intuitive Surgical, Sunnyvale, CA, USA. Walter Artibani was lecturer for Astellas, Ipsen, Zambon. Vincenzo Ficarra was speaker for Intuitive Surgical, Sunnyvale, CA, USA. Giacomo Novara was lecturer/advisory board member for Astellas, Eli Lilly, Pierre Fabre, Provenge, Recordati Int., Takeda. Medical writer Stephen R. Braun provided valuable editorial assistance in the preparation of this white paper. The Pasadena Consensus Conference was organized by New England Research Institutes, Inc. (Watertown, MA, USA) and funded entirely through a grateful patient donation to City of Hope National Medical Center (Duarte, CA). No representatives of the company producing the only robotic system currently on the market attended the conference. In addition, no commercial sponsors were accepted in connection with the conference.

abstract

  • Context: Radical retropubic prostatectomy (RRP) has long been the most common surgical technique used to treat clinically localized prostate cancer (PCa). More recently, robot-assisted radical prostatectomy (RARP) has been gaining increasing acceptance among patients and urologists, and it has become the dominant technique in the United States despite a paucity of prospective studies or randomized trials supporting its superiority over RRP. Objective: A 2-d consensus conference of 17 world leaders in prostate cancer and radical prostatectomy was organized in Pasadena, California, and at the City of Hope Cancer Center, Duarte, California, under the auspices of the European Association of Urology Robotic Urology Section to systematically review the currently available data on RARP, to critically assess current surgical techniques, and to generate best practice recommendations to guide clinicians and related medical personnel. No commercial support was obtained for the conference. Evidence acquisition: A systematic review of the literature was performed in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Evidence synthesis: The results of the systematic literature review were reviewed, discussed, and refined over the 2-d conference. Key recommendations were generated using a Delphi consensus approach. RARP is associated with less blood loss and transfusion rates compared with RRP, and there appear to be minimal differences between the two approaches in terms of overall postoperative complications. Positive surgical margin rates are at least equivalent with RARP, but firm conclusions about biochemical recurrence and other oncologic end points are difficult to draw because the follow-up in existing studies is relatively short and the overall experience with RARP in locally advanced PCa is still limited. RARP may offer advantages in postoperative recovery of urinary continence and erectile function, although there are methodological limitations in most studies to date and a need for well-controlled comparative outcomes studies of radical prostatectomy surgery following best practice guidelines. Surgeon experience and institutional volume of procedures strongly predict better outcomes in all relevant domains. Conclusions: Available evidence suggests that RARP is a valuable therapeutic option for clinically localized PCa. Further research is needed to clarify the actual role of RARP in patients with locally advanced disease. (C) 2012 Published by Elsevier B.V. on behalf of European Association of Urology.

authors

Publication Date

  • September 1, 2012

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published in

category

start page

  • 368

end page

  • 381

volume

  • 62

issue

  • 3

WoS Citations

  • 138
  • 141

WoS References

  • 102