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Significance of Prostate Weight on Peri and Post Operative Outcomes of Robot-Assisted Laparoscopic Extra Peritoneal Prostatectomy.
Satya Allaparthi, MRCS, MD, Thomas Hoang, MD, Nadeem N. Dhanani, MD, MPH Ingolf A. Tuerk, MD, PhD.
Caritas St Elizabeth Hospital, Boston, MA, USA.

OBJECTIVES
To determine the significance of prostate weight (PW) on clinical and pathological outcomes in patients undergoing da Vinci assisted robotic assisted laparoscopic extra- peritoneal radical prostatectomy (EP-RARP) .
METHODS
From November 2008 to January 2010, 295 men underwent EP-RARP at our institution. We retrospectively reviewed our IRB approved database and patients were stratified into four groups on the basis of the pathologic PW as group 1, less than 30 g; group 2, 30 g or more to less than 50 g; group 3, 50 g or more to less than 80 g; and group 4, 80 g or larger and compared prospectively. In this analysis we assessed various variables that included patient age, body mass index, prostate specific antigen, Gleason score, pathological stage, margin status, operative time, blood loss, transfusion rate and length of stay. Statistical analysis was performed using SYSTAT 13 ® soft ware on a computer. An analysis of variance model was used to compare the continuous outcome variables among the groups. Chi-square and Fisher’s exact tests were used to compare categorical outcome variables.
RESULTS
Of the 295 patients, 10, 182, 91, and 12 had a PW of less than 30 g, 30 g or more to less than 50 g, 50 g or more to less than 80 g, and 80 g or larger, respectively. A significant difference was found in age , prostate weight and prostate-specific antigen values among the four groups (p<0.05). Patients in-group 4 have larger prostates, were older (mean age 65 years), had higher pretreatment prostate specific antigen (median 5.85 ng/ml) and lower Gleason score (mean 6.2). Based on D’Amico risk stratification, our study showed a trend toward higher risk disease, evidence of extra capsular extension , seminal vesicle invasion and positive margin status in group 1 ,2 and 3. No significant
differences in operative time, estimated blood loss, transfusion rate, hospital stay, and post operative complication rate were observed among the four groups.
CONCLUSIONS
Da Vinci assisted robotic EP RARP is feasible in patients of enlarged prostates with acceptable operative times, blood loss , hospital stay and complication rates. In our cohort of patients we found, pathologically smaller prostates are generally associated with higher Gleason score, higher risk group stratification and positive surgical margin status. Although, technically challenging patients with large prostate weight should not be considered as a contraindication for EP RARP by experienced surgeons.
Pre-operative characterstics:

Variable<30 g>30,<50>50,<80>80P value
Patients (n)101829112
Race (%)
White
Asian
Hispanic
African American
10(100)173(95)
1(0.6)
4(2.2)
4(2.2)
91(100)12(100)0.758
Mean ±SD (yr) age at surgery55.3±9.758.5±6.461±7.365±6<0.001
Mean ±SD Prostate weight(g)27.7±1.01640.3±4.860.3±7.3102±14.8<0.01
Median Serum PSA(ng/dl)(IQR)3.7 (0.6-30.4)4.7 (0.5-18.7)5.2(0.6-22)5.85( 4.2-13.9)0.004
Mean ±SD BMI (kg/m²)26.6±3.97527.4±3.427.2±3.328.9±3.50.350
Preoperative Gleason score (%)
5-6
7 (3+4)
7 (4+3)
8
9 (4+5)
9(5+4)
10 (5+5)
6 (60)
2 (20)
1 (10)
1 (10)
0
0
0
88(48.9)
53(29.5)
25 (13.8)
12 (6.6)
2 (1.1)
0
0
56(61.5)
22(24.1)
8(8.8)
2(2.2)
2(2.2)
1(1.2)
9(75)
3(25)
<0.01

Intraoperative characteristics
Variable<30>30,<50>50,<80>80p-value
Patients (n)101829112
Mean±SD operative time (mins)129.1± 28.2127.2 ± 19.7127.6±3.3127±20.50.988
Median EBL (ml) IQR200 (100-550)150 (25-1200)200(50-1200)162.5(50-550)0.231
Post operative Gleason score(%)<0.001
5-63 (30)47 (26.1)35(38.5)7(63.6)
7 (3+4)6(60)97 (53.8)37(40.7)5(36.4)
7 (4+3)028 (15.5)10(11)
81(10)4 (2.2)3(3.2)
9 (4+5)4 (2.2)4(4.3)
9(5+4)1(1)
10 (5+5)1(1)
No.seminal vesicle invasion (%)
Neg
Pos
7 (70)
3 (30)
172 (94.5)
10 (5.5)
87(95.6)
4(4.3)
12(100)0.013
No.extra capsular extension (%)
Neg
Pos
7 (70)
3 (30)
122 (67)
60 (33)
71(78)
20(22)
12(100)0.049
Nerve sparing (%)
None
Unilateral
Bilateral
1(10)
2(20)
7(70)
19 (10)
29 (16)
134(74)
16(17.5)
17(18.9)
58(63.7)
4(33.3)
2(16.6)
5(50)
0.173
Lymphnode dissection(%)
None
Unilateral
Bilateral
5(50)
2(20)
3(30)
82(45)
46(25)
54 (30)
53(58.2)
20(22)
18(19.8)
9(75)
2(16.6)
1(8.3)
0.352
Pathological stage(%)
pT2a
13(7.2)9(9.8)3(25)0.076
PT2c7 (70)108(58.3)61(67)9(75)
pT3a51(29)16(17)
pT3b3 (30)10 (5.5)5(6.2)
Positive margin(%)
Negative
Positive
pT2
pT3
6(60)
4(40)
2(20)
2(30)
141(77.5)
41(22.5)
18(9.8)
23(12.8)
81(89.1)
10(10.9)
5(50)
5(50)
11(91.6)
1(8.3)
1(8.3)
<0.001

Postoperative Characterstics
Variable<30>30,<50>50,<80>80p-value
No.of patients(n)101829112
Mean length of hospital stay (days)11.2 (1-12)1.02(1-2)1.4 (1-5)0.4
No. transfusion (%)02(2.66)1(0.7)0
Post operative complications (Clavien classification)
I
IIa
IIb
III
0
1 (lymphocele)
0
0
3
6 (lymphocele)
1 Post op MI
0
0
2(lymphocele),1 leak
0
0
0
0
0
0
0.159

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