Robotic Prostatectomy Surgical Time Correlates with Specimen Autolysis
AP Modi, AP Patel, GN Box, DS Sharp, A Shabsigh, R Abaza, DL Zynger. The Ohio State Medical Center, Columbus, OH
Background: Appropriate pathologic interpretation of prostatectomy specimens is vital to postoperative patient management. We have observed more substantial autolytic changes in specimens from robotic radical prostatectomies compared with those from open procedures. This may be related to longer exposure to body temperature after devascularization prior to specimen extraction as the prostate in a robotic procedure remains in the abdomen after being devascularized while in an open prostatectomy the prostate is immediately removed following devascularization. As such, we hypothesized that increased surgical time during robotic prostatectomy might be associated with more autolytic artifact.
Design: A retrospective review was undertaken for 85 robotic prostatectomy patients treated between January and October 2009 by four different surgeons. All prostates had been sent for immediate grossing and whole mount processing after extraction. These original sections were re-reviewed by a GU pathologist to assess percent autolysis at the apex, mid and base levels generating a measure of average autolysis per specimen. Multivariate regression analysis using total autolysis as the dependent variable was performed using SPSS 17.0 with a Bonferroni-adjusted p value of < 0.004 for significance.
Results: Mean age of the patient was 60 years old. Mean surgical time and autolysis was 229 minutes and 4.8%, respectively. The correlation coefficient between total percent autolysis and surgical time was 0.603 (p <0.001). There was no statistically significant correlation between autolysis and PSA, Gleason score, % tumor, prostate size, maximum length of prostate, surgeon, margin positivity, node status, age, or use of preoperative medication for BPH. Above a cutoff point of 4.5 hours, there was a mean 8.8% autolysis versus 2.7% autolysis below 4.5 hours using the paired sample t-test (p <0.001). In one specimen, margin status was indeterminate due to autolysis artifact.
Conclusions: Length of time for robotic procedures is significantly correlated with degree of autolysis in the prostate. Longer procedures may influence the ability to evaluate pathologic parameters such as margin status. This information could be used to encourage urologists to perform the prostatectomy portion of the robotic procedure after the lymph node dissection to decrease the warm ischemia time of the prostate.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 118, Tuesday Afternoon