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The Impact of.Multidisciplinary Care in a Large Volume Robot-Assisted Radical Prostatectomy Program: A Paradoxical Stage Migration toward More Aggressive Disease

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Open Journal of.Internal Medicine 2014年第4期4卷 108-114页

作者： jospeh f. renzulli ii Michael M. Maddox Omar Nadeem Simone Thavaseelan Gyan Pareek Anthony E. Mega Warren Alpert Medical School Brown University Providence USA

Introduction: With the widespread use of.robot-assisted radical prostatectomy (RARP), a stage migration to less aggressive prostate cancer (CaP) may be expected in pathological specimens due to over-treatment of.low risk disease. It is unclear whether implementation of.a multidisciplinary clinic (MDC) model would of.set this phenomenon. We sought to analyze our database f.r possible stage migration in prostatectomy specimens in the setting of.MDC. Methods: A total of.262 patients who underwent open prostatectomy (OP) f.om 2004 to 2006 and 757 patients who underwent RARP f.om 2007 to 2011 were identif.ed f.om our prospective database. The implementation of.MDC occurred concurrently at the time of.RARP initiation. Demographic data, pathology, positive margin rates along with standard CaP reporting data were recorded. The two groups were compared with regards to percentage of.cases stratif.ed by Gleason grade. Results: The number of.CaP cases managed at our institution increased considerably af.er the introduction of.robotics and MDC. There was a signif.cant decrease in the patients with Gleason 6 CaP undergoing RARP as compared with OP (p = 0.001). Additionally, RARP was perf.rmed on a signif.cantly greater percentage of.Gleason 7 disease (p f.cant increase in the incidence of.pT3 disease f.llowing RARP (p f.a MDC and minimally invasive radical prostatectomy did not result in an increased application of.surgery f.r the treatment of.low risk prostate cancer. This highlights the importance of.MDC in a large volume RARP program.

关键词： Prostate Cancer Robotics Multidisciplinary Care

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