Based on the increasing number of robotic radical prostatectomy cases per year and da Vinci surgical systems installed, robotic prostatectomy is a viable option in Eastern Europe, particularly in Turkey, according to Assoc. Prof. A. Erdem Canda (TR). Currently, it has 34 da Vinci surgical systems, making it the country with the most installed in the region (Russia comes in second with 25). And so far, more than 1,200 robotic prostatectomy cases were performed this year.
“There is a steady increase in the number of robotic prostatectomy cases in Turkey,” said Canda. “In 2014, around 1,200 cases were performed. Last year, there were more than 1,600 cases.”
Canda presented these statistics in his lecture “From open to robotic prostatectomy: Is it a viable option in Eastern Europe?” on 23 September at the 12th South Eastern European Meeting, which took place in Sarajevo, Bosnia and Herzegovina.
RARP or open surgery in high-risk PCa?
Canda cited findings of the Swedish Observational study “Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes” published in 2014, that surgery is superior to radiotherapy in treating high-risk PCa. The study has a 15-year cancer specific data (CSS) but with a significantly longer CSS in the surgery group.
“Currently, we don’t have long-term oncological follow-up data in open versus robotic in high-risk PCa patients in order to conclude if robotic approach is better than open surgery. Do we need to wait for the 15-year data or for a randomized study?” said Canda. “There is not enough evidence to determine whether robotic surgery is inferior nor proven to be superior than open surgery. The debate is still open.”
Canda also cited publications which stated the similarities between open surgery and robot-assisted radical prostatectomy (RARP) in high-risk PCa. Both surgeries have similar oncologic outcomes, outcomes in terms of (+) SMs and biochemical recurrence, (+) SMs and additional cancer therapy rates, recurrence-free survival, and complication rates. A few of the publications stated that there are more complete bilateral nerve sparing in RARP, less blood loss, lower rates of blood transfusions, and shorter hospital stay.
“The next generation of surgeons do not want to be trained in open surgery but in robotic surgery instead,” said Canda. He cited statements by Assoc. Prof. Declan Murphy (Urologist and Director of GU Oncology, Peter MacCallum Cancer Centre, University of Melbourne) that robots provide significant advantages in training such as enhanced and magnified 3D vision, higher grades of wristed hand movement, and avoidance of hand tremor.
“The trainees will be able to acquire skills outside the operating room and then bring them in,” Canda said. “Our centre [Yildirim Beyazit University, School of Medicine at the Ankara Ataturk Training & Research Hospital] is recently certified as a ERUS Robotic Training Centre so we train colleagues for prostate cancer surgery.”
However, reliance on robotic surgery alone should not be the only option. Canda said, “What if there’s an emergency open surgery and the robot is not available or malfunctioning, or what if there are complications? These are the questions we should also keep in mind.”