Changing face of robot‐assisted radical prostatectomy in Melbourne over 12 years

Background This study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in Melbourne, Australia. Methods All patients undergoing an RARP between 2004 and October 2016 while under the care of six high‐volume surgeons were inc...

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Vydáno v:	ANZ journal of surgery Ročník 88; číslo 3; s. E200 - E203
Hlavní autoři:	Sathianathen, Niranjan J., Lamb, Alastair D., Lawrentschuk, Nathan L., Goad, Jeremy R., Peters, Justin, Costello, Anthony J., Murphy, Declan G., Moon, Daniel A.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Melbourne John Wiley & Sons Australia, Ltd 01.03.2018 Blackwell Publishing Ltd
Témata:	Age Age Factors Aged Australia Biopsy Cancer Cancer surgery Demographics Demography Health risks Humans laparoscopic surgery Male Medical personnel Men Middle Aged Neoplasm Grading Neoplasm Staging Patient Selection Patients Prostate cancer Prostatectomy Prostatectomy - statistics & numerical data Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Quality Risk Risk groups Robotic surgery robotic surgical procedure Robotic Surgical Procedures - statistics & numerical data Trends Tumors Urological surgery Australia Melbourne Victoria Australia prostatectomy prostate cancer robotic surgical procedure laparoscopic surgery
ISSN:	1445-1433, 1445-2197, 1445-2197
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Abstract	Background This study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in Melbourne, Australia. Methods All patients undergoing an RARP between 2004 and October 2016 while under the care of six high‐volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer. Results Over the 12‐year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high‐risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016. Conclusion Our analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease.
AbstractList	BackgroundThis study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in Melbourne, Australia.MethodsAll patients undergoing an RARP between 2004 and October 2016 while under the care of six high‐volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer.ResultsOver the 12‐year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high‐risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016.ConclusionOur analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease. This study aims to characterize the trends in disease presentation for robot-assisted radical prostatectomy (RARP) over a 12-year period in Melbourne, Australia. All patients undergoing an RARP between 2004 and October 2016 while under the care of six high-volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer. Over the 12-year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high-risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016. Our analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease. Background This study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in Melbourne, Australia. Methods All patients undergoing an RARP between 2004 and October 2016 while under the care of six high‐volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer. Results Over the 12‐year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high‐risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016. Conclusion Our analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease. This study aims to characterize the trends in disease presentation for robot-assisted radical prostatectomy (RARP) over a 12-year period in Melbourne, Australia.BACKGROUNDThis study aims to characterize the trends in disease presentation for robot-assisted radical prostatectomy (RARP) over a 12-year period in Melbourne, Australia.All patients undergoing an RARP between 2004 and October 2016 while under the care of six high-volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer.METHODSAll patients undergoing an RARP between 2004 and October 2016 while under the care of six high-volume surgeons were included in this study. Data were collected prospectively regarding patient demographics and clinical details of their cancer.Over the 12-year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high-risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016.RESULTSOver the 12-year time span of the study, 3075 men underwent an RARP with a median age of 63.01 years. Temporal analysis demonstrated that the median age of patients undergoing prostatectomy advanced with time with the median age in 2016 being 65.51 years compared with 61.0 years in 2004 (P < 0.001). There was also a significant trend to increased D'Amico risk groups over time with the percentage procedures for high-risk patients increasing from 12.6% to 28.10% from 2004 to 2016 (P < 0.001). Upgrade rates between biopsy and pathological Gleason grade scoring significantly trended down over the period of the study (P < 0.001). There was also a shift to increased pathological stage over the 12 years with 22.1% of men having T3 disease in 2004 compared with 49.8% in 2016.Our analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease.CONCLUSIONOur analysis demonstrates increasing treatment of older men with higher risk tumours, consistent with international trends. While this largely reflects a shift in case selection, further work is needed to assess whether the stage shift may relate partially to a decline in screening and increased presentation of higher risk disease.
Author	Costello, Anthony J. Goad, Jeremy R. Murphy, Declan G. Peters, Justin Moon, Daniel A. Lawrentschuk, Nathan L. Lamb, Alastair D. Sathianathen, Niranjan J.
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Cites_doi	10.1001/jama.1997.03540420048028 10.1067/msy.2002.125315 10.1089/end.2016.0659 10.1111/bju.13513 10.1111/bju.13247 10.4103/0974-7796.152052 10.1111/bju.13031 10.1111/bju.13602 10.1001/jama.1995.03520310046028 10.1111/j.1464-410X.2011.10759.x 10.1016/S0022-5347(01)66316-X 10.1016/j.eururo.2013.10.030 10.1111/bju.13317 10.5489/cuaj.3684 10.1111/bju.13049 10.1089/end.2014.0242
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Snippet	Background This study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in... This study aims to characterize the trends in disease presentation for robot-assisted radical prostatectomy (RARP) over a 12-year period in Melbourne,... BackgroundThis study aims to characterize the trends in disease presentation for robot‐assisted radical prostatectomy (RARP) over a 12‐year period in...
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SubjectTerms	Age Age Factors Aged Australia Biopsy Cancer Cancer surgery Demographics Demography Health risks Humans laparoscopic surgery Male Medical personnel Men Middle Aged Neoplasm Grading Neoplasm Staging Patient Selection Patients Prostate cancer Prostatectomy Prostatectomy - statistics & numerical data Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Quality Risk Risk groups Robotic surgery robotic surgical procedure Robotic Surgical Procedures - statistics & numerical data Trends Tumors Urological surgery
Title	Changing face of robot‐assisted radical prostatectomy in Melbourne over 12 years
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