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Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel.
Eur Urol. 2012 Sep; 62(3):368-81.EU

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.

Authors+Show Affiliations

Vita-Salute San Raffaele University, Milan, Italy. montorsi.francesco@hsr.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Consensus Development Conference
Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22763081

Citation

Montorsi, Francesco, et al. "Best Practices in Robot-assisted Radical Prostatectomy: Recommendations of the Pasadena Consensus Panel." European Urology, vol. 62, no. 3, 2012, pp. 368-81.
Montorsi F, Wilson TG, Rosen RC, et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol. 2012;62(3):368-81.
Montorsi, F., Wilson, T. G., Rosen, R. C., Ahlering, T. E., Artibani, W., Carroll, P. R., Costello, A., Eastham, J. A., Ficarra, V., Guazzoni, G., Menon, M., Novara, G., Patel, V. R., Stolzenburg, J. U., Van der Poel, H., Van Poppel, H., & Mottrie, A. (2012). Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. European Urology, 62(3), 368-81. https://doi.org/10.1016/j.eururo.2012.05.057
Montorsi F, et al. Best Practices in Robot-assisted Radical Prostatectomy: Recommendations of the Pasadena Consensus Panel. Eur Urol. 2012;62(3):368-81. PubMed PMID: 22763081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. AU - Montorsi,Francesco, AU - Wilson,Timothy G, AU - Rosen,Raymond C, AU - Ahlering,Thomas E, AU - Artibani,Walter, AU - Carroll,Peter R, AU - Costello,Anthony, AU - Eastham,James A, AU - Ficarra,Vincenzo, AU - Guazzoni,Giorgio, AU - Menon,Mani, AU - Novara,Giacomo, AU - Patel,Vipul R, AU - Stolzenburg,Jens-Uwe, AU - Van der Poel,Henk, AU - Van Poppel,Hein, AU - Mottrie,Alexandre, AU - ,, Y1 - 2012/06/07/ PY - 2012/02/22/received PY - 2012/05/25/accepted PY - 2012/7/6/entrez PY - 2012/7/6/pubmed PY - 2013/1/8/medline SP - 368 EP - 81 JF - European urology JO - Eur Urol VL - 62 IS - 3 N2 - 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. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/22763081/Best_practices_in_robot_assisted_radical_prostatectomy:_recommendations_of_the_Pasadena_Consensus_Panel_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(12)00641-0 DB - PRIME DP - Unbound Medicine ER -