Robot-assisted radical prostatectomy of clinical high-risk patients with prostate cancer: A controlled study of operative and short-term postoperative events

Objective. Robot-assisted laparoscopic prostatectomy (RALP) has increasingly become a treatment alternative for patients with high-risk prostate cancer. Few papers focus on the prevalence of operative and short-term postoperative (<30 days) adverse events associated with RALP in high-risk patients. The objective of this study was to study such events in high-risk patients using intermediate-and low-risk patients as contrast groups. Material and methods. In total, 1076 patients who underwent RALP at Oslo University Hospital, Radiumhospitalet, between the start of 2005 and end of 2010 were studied. Based on the D'Amico classification the sample consisted of 374 (35%) high-, 475 (44%) intermediate-and 227 (21%) low-risk patients. An index of seven adverse effects was dichotomized into zero or any number of adverse effects. Results. The high-risk group had significantly longer operation time, more positive surgical margins, larger prostate volume and less nerve-sparing than the contrast groups. No between-group differences were observed for reoperation, catheter time, bleeding volume or transfusions. Significantly more Clavien complications were observed in the high-risk than in the low-risk group. A positive adverse effect index score was associated with positive margins, no nerve-sparing surgery and no preoperative magnetic resonance imaging, and negatively associated with the second and third of three 2-year study periods. Conclusions. High-risk patients had a significantly higher risk of some operative and short-term postoperative adverse events than the control groups. This was not the case for the seven-items adverse event index. This study does not support any restricted attitude towards RALP in high-risk patients, except for general surgical contraindications.