Pentafecta Outcomes of 230 Cases of Robotic-assisted Radical Prostatectomy with Bilateral Neurovascular Bundle Preservation

Yen-Chuan Ou; Chun-Kuang Yang; Hsun-Ming Kang; Kuangh-Si Chang; John Wang; Siu-Wan Hung; Min-Che Tung; Ashutosh K Tewari; Vipul R Patel

Pentafecta Outcomes of 230 Cases of Robotic-assisted Radical Prostatectomy with Bilateral Neurovascular Bundle Preservation

Anticancer Res. 2015 Sep;35(9):5007-13.

Authors

Yen-Chuan Ou¹, Chun-Kuang Yang², Hsun-Ming Kang³, Kuangh-Si Chang⁴, John Wang⁵, Siu-Wan Hung⁶, Min-Che Tung⁷, Ashutosh K Tewari⁸, Vipul R Patel⁹

Affiliations

¹ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. ycou228@gmail.com.
² Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
³ Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
⁴ Department of Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
⁵ Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
⁶ Department of Radiation, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
⁷ Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, R.O.C. School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
⁸ School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
⁹ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A.

PMID: 26254400

Abstract

Aim: We analyzed pentafecta outcomes [complication-free, continence, potency, negative surgical margins (NSM)], biochemical recurrence (BCR)-free] of 230 patients undergoing robotic-assisted radical prostatectomy (RARP) with bilateral neurovascular (NVB) preservation.

Patients and methods: Patient outcomes (group I, cases 1-115; group II, cases 116-230) were assessed prospectively. Definitions were: continence, using no pads; potency, ability to achieve/maintain erections firm enough for sexual intercourse; positive surgical margin, presence of tumor tissue on inked specimen surface; and BCR, two consecutive PSA levels >0.2 ng/ml after RALP.

Results: The mean patient age was 62.5 years, mean PSA=8.62 ng/ml. The complication-free rate was 93.9% (216/230), continence rate 98.3% (226/230), potency 86.1% (198/230), NSM 77.0% (177/230) and BCR-free 92.6% (213/230). The trifecta rate (continence, potency, BCR-free) was 81.7% (188/230). The pentafecta rate was 60.4% (139/230).

Conclusion: Pentafecta is the new standard of outcomes for RARP with bilateral NVB, with patient selection and reduced positive surgical margins attaining best outcomes.

Keywords: Biochemical recurrence; laparoscopy; pentafecta; prostate cancer; radical prostatectomy; robotics.

MeSH terms

Humans
Male
Middle Aged
Organ Sparing Treatments*
Prostate-Specific Antigen / metabolism
Prostatectomy*
Prostatic Neoplasms / surgery*
Robotics*
Treatment Outcome

Substances

Prostate-Specific Antigen