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Purpose: We aimed to compare perioperative outcomes, post-operative complications, and opioid use between AirSeal® and non-AirSeal® robotic-assisted radical prostatectomy (RARP). Methods: We retrospectively collected data on 326 patients who underwent elective RARP at our institution either with or without AirSeal®. The first 60 cases were excluded accounting for the institutions' learning curve of RARP. Patient demographics, oncologic, pathologic, and surgical characteristics between AirSeal® and non-AirSeal® cases were compared. Furthermore, outcomes of interest including operative time, length of stay, morbidity, and opioid use for pain management were compared between the two groups. Univariate linear and logistic regression models were developed. Results: The AirSeal® group consisted of 125 (38.3%) patients while the non-AirSeal® group consisted of 201 (61.7%) patients. No statistically significant difference was seen in terms of patient demographics, oncologic characteristics, surgical characteristics, and pathologic characteristics between the two groups. In addition, univariate linear regression showed that RARP with AirSeal® displayed shorter operative times by 12.3 min and a shorter length of hospital stay by 0.5 days compared to the non-AirSeal® group (p < 0.001). Furthermore, the AirSeal® group witnessed lower odds of Clavien-Dindo (CVD) Class > 2 complications (OR = 0.102) and a lower need for opioid use (OR = 0.49) compared to the non-AirSeal® group (p < 0.022). Conclusion: RARP using AirSeal® is associated with shorter operative times, shorter length of hospital stays, lower odds of CVD > 2 complications, and lower odds of opioid use with respect to non-AirSeal® RARP. The efficacy and cost effectiveness of using the AirSeal® system during RARP should be further studied and evaluated by clinical trials. [ABSTRACT FROM AUTHOR]

To assess the safety and surgical outcomes of radical prostatectomy (RP) when looking at age as an independent risk factor of perioperative mortality and morbidity. A retrospective cohort study was performed using American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent a RP from 2008 to 2015 were identified. They were divided into three groups based on their age 15 group at the time of surgery. Patients' characteristics were compared across the three following age groups: 74 years. The correlation between the three different age groups and their respective 30-day postoperative mortality and morbidity were assessed using logistic regression. Unadjusted and adjusted odds ratios (ORs) were estimated. A total of 43025 patients were identified, 81.7% were aged 74 years. Overall, 102 patients died in the 30-day postoperative period. Univariate and multivariate analysis showed a significant increase in the 30-day postoperative mortality from 0.1% to 0.4% to 1.3% in the three different age groups 74 years, respectively. In addition, there was a significant increase in postoperative complications in the group of patients aged >74 years. A higher risk of complications 25 related to cardiac (OR 2.18 in age group 70–74 vs OR 7.45 in age group >74 years), respiratory (OR 2.36 vs OR 5.91), neurological (OR 2.28 vs OR 3.44), wound infections (OR 1.49 vs OR 3.25), and sepsis (OR 1.54 vs OR 2.64) were seen with the youngest group taken as a reference. Age is an independent risk factor for perioperative mortality and morbidity after RP in elderly patients. Therefore, age should be considered in the decision making of therapeutic options for patients with prostate cancer. BMI: body mass index; CNS: central nervous system; SIOG: International Society of Geriatric Oncology; SEER: Surveillance, Epidemiology, and End Results; ACS: American College of Surgeons; NSQIP: National Surgical Quality Improvement Program; OR: odds ratio [ABSTRACT FROM AUTHOR]

Objective: The available nomograms used to predict lymph node involvement (LNI) are not comprehensive. We sought to derive a novel nomogram incorporating the platelet to lymphocyte ratio (PLR) to predict LNI and compare its performance to validated preoperative risk nomograms in a cohort of men undergoing robotic-assisted radical prostatectomy at our institution.Methods: Our electronic health record was queried for patients who underwent robotic-assisted radical prostatectomy with bilateral pelvic lymphadenectomy between 2013 and 2019. A bootstrapped multivariate logistic regression model was constructed for the predictors of LNI while adjusting for other covariates. Then, we used the derived logistic regression formula to estimate each patient's risk (%) for LNI. Individualized risks were also calculated using the following verified nomograms: Briganti-2012, Cagiannos, Godoy, and Memorial Sloan Kettering Cancer Center. Subsequently, we plotted the risks for our nomogram and the 4 verified nomograms into receiver operating characteristics curves. We reported the area under the curve (AUC) for each of the 5 nomograms and the corresponding 95% confidence interval (CI).Results: The cohort included 173 patients, of which 13.9% demonstrated LNI. LNI was associated with higher preoperative prostate-specific antigen (PSA) ≥ 10 [odds ratio [OR] = 4.89; 95% confidence interval [CI] (1.42-16.83)], higher grade (WHO group ≥ 3)[19.21; (2.23-195.25)], and higher percentage of positive biopsy cores (≥60%) [3.38, (1.04-11.00)]. With every 30-unit increase in PLR the risk of LNI increased by 47%. The nomogram derived from our data had the highest AUC [(AUC 0.877; 95% CI (0.806-0.947)]. The Memorial Sloan Kettering Cancer Center and Briganti 2012 displayed almost congruent ability [0.836; 95% CI (0.758-0.915)] and [0.827; (0.752-0.902)] to identify patients with positive nodes in our cohort with perfect sensitivity and negative predictive value.Conclusion: The nomogram incorporating PLR demonstrated 94.7% sensitivity to predict LNI and avoided pelvic lymphadenectomy in half of the patients at a cut-off between 6.5% and 8.5%. A prospective study with a larger sample is needed to validate our findings. [ABSTRACT FROM AUTHOR]