Kidon Chang

Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size.

To investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy (RS‐RALP).

Prostate-specific antigen 10–20 ng/mL: A predictor of degree of upgrading to ≥8 among patients with biopsy Gleason score 6

Purpose This study aimed to identify the predictors of upgrading and degree of upgrading among patients who have initial Gleason score (GS) 6 treated with robot-assisted radical prostatectomy (RARP). Materials and Methods A retrospective review of the data of 359 men with an initial biopsy GS 6, localized prostate cancer who underwent RARP between July 2005 to June 2010 was performed. They were grouped into group 1 (nonupgrade) and group 2 (upgraded) based on their prostatectomy specimen GS. Logistic regression analysis of studied cases identified significant predictors of upgrading and the degree of upgrading after RARP. Results The mean age and prostate-specific antigen (PSA) was 63±7.5 years, 8.9±8.77 ng/mL, respectively. Median follow-up was 59 months (interquartile range, 47–70 months). On multivariable analysis, age, PSA, PSA density and ≥2 cores positive were predictors of upgrading with (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.06; p=0.003; OR, 1.006; 95% CI, 1.01–1.11; p=0.018; OR, 0.65; 95% CI, 0.43–0.98, p=0.04), respectively. On subanalysis, only PSA level of 10–20 ng/mL is associated with upgrading into GS ≥8. They also had lower biochemical recurrence free survival, cancer specific survival, and overall survival (p≤0.001, p=0.003, and p=0.01, respectively). Conclusions Gleason score 6 patients with PSA (10–20 ng/mL) have an increased risk of upgrading to pathologic GS (≥8), subsequently poorer oncological outcome thus require a stricter follow-up. These patients should be carefully counseled in making an optimal treatment decision.

Proctorship and mentoring: Its backbone and application in robotic surgery.

In pursuit of continuing medical education in robotic surgery, several forms of training have been implemented. This variable application of curriculum has brought acquisition of skills in a heterogeneous and unstandardized fashion from different parts of the world. Recently, efforts have been made to provide cost effective and well-structured curricula with the aim of bridging the gap between formal fellowship training and short courses. Proctorship training has been implicated on some curriculum to provide excellent progression during the learning curve while ensuring patient safety.

MP49-18 OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: HOW FAR SHALL WE PROCEED?

INTRODUCTION AND OBJECTIVES: Minimization or reducing on-clamp time during PN has led to alternative technical modifications. The concept of off-clamp PN aims to avoid the ischemic injury on the healthy parenchyma. The purpose of this study was to compare the outcomes of off-clamp to on-clamp approach during robot-assisted partial nephrectomy (RAPN). METHODS: Retrospective study of 940 patients who underwent RAPN between 2007 and 2016 for cT1a tumors using on-clamp or off-clamp approaches. We matched the patients in terms of confounding variables. Overall, 309 patients with on-clamp technique were matched to 103 patients with off-clamp technique. We compared the clinico-pathological characteristics, perioperative morbidity and late functional outcomes between the propensity score matched groups. The excisional volume loss was calculated on pathology specimen. Postoperative e-GFR was calculated between 3 to 12 months after PN. RESULTS: There were no difference in clinico-pathological characteristics between the 2 matched groups. While operative time (p1⁄40.4), estimated blood loss (p1⁄40.28), Clavien grade III-V complications (p1⁄40.8), surgical reoperation (p1⁄41), 30-day readmission (p1⁄41) positive surgical margin (5.5% vs. 5.8%, p 1⁄40.9) were comparable between the 2 groups, there were significant difference in excisional volume loss (median, 7.08 vs. 3.51 cm3, p<0.01), e-GFR decline (median, -9.7 vs. -2.2 ml/min/1.73m2, p<0.01), percent of e-GFR preservation (median, 87% vs. 97%, p<0.01), and CKD upstaging (36.5% vs. 23.3%, p1⁄40.01) in favor of off-clamp group. Excisional volume loss (p1⁄40.01), off-clamp approach (p1⁄40.01), and age (p1⁄40.02) were predictors of renal function preservation, whereas excisional volume loss (OR1⁄41.035, CI 95% [1.015-1.06], p<0.01) predicted CKD upstaging. CONCLUSIONS: RAPN for selected renal mass using offclamp approach offered renal functional advantage over on-clamp, without adding morbidities. Excisional volume loss, off-clamp approach, and age were independent predictors of renal function preservation.