Medical Student Research Fellowship for Summer 2010
Mentor: Yair Lotan
Room number: J8.112
Mail Code: 9110
Phone number: 8-0389
Project title: Oncologic and quality of life outcomes after robot-assisted laparoscopic prostatectomy
Human subjects IRB approved project number (where applicable): IRB 1203-756
Animal subjects IRB approved project number (where applicable):
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)
Brief Description of Project:
Prostate cancer is the most common cancer in men with close to 200,000 new cases diagnosed each year. Radical prostatectomy (RP) represents the most common treatment for prostate cancer performed in the U.S. New technologies, such as laparoscopic (LRP) and robotic-assisted (RALP) approaches to RP have been developed. The demand and utilization of these minimally-invasive surgical treatments has increased in recent years, whereas utilization of open retropubic RP (RRP) has decreased. While minimally-invasive approaches offer the benefit of decreased blood loss and shorter hospital stay, the need for more expensive equipment may have a significant impact on health economics. Only evidence for improved patient care when performing RALP could justify the high costs for this procedure.
A recent systematic review of the literature for prostatectomy procedures identified 37 comparative studies. LRP and RALP were more time consuming than RRP, especially in the initial steps of the learning curve, but blood loss, transfusion rates, length of stay, and complication rates all favored minimally invasive approaches (LRP and RALP). The available studies were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. Minimally-invasive RP results in lower transfusion rates and more rapid convalescence with shorter LOS. The decrease in pain and length of stay has been questioned by several studies which utilized similar pathways to discharge for RALP and RRP. Webster et al. prospectively compared postoperative pain scores among 314 patients who underwent RALP or RRP and found no differences in pain or analgesic use. Unfortunately, no randomized trials compared outcomes for different surgical approaches to RP and no significant advantages in functional outcomes and cancer control for the RALP approach have yet been observed.
Since 2005, we have performed over 500 RALP procedures at our institution. The goal of this study is to determine operative, pathological and early functional parameters of patients undergoing robot assisted laparoscopic radical prostatectomy (RALP) during the learning curve of a single surgeon with a large prior experience with radical open prostatectomy.
Previous Research Activities or Publications with Medical Students:
1. Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, Lotan Y. Cost
Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate
Cancer. Eur Urol. 2009 Nov 11. [Epub ahead of print]PMID: 19931979
2. Schlomer BJ, Ho R, Sagalowsky A, Ashfaq R, Lotan Y. Prospective Validation of the Clinical Usefulness of Reflex Fluorescence In Situ Hybridization Assay in Patients With Atypical Cytology for the Detection of Urothelial Carcinoma of the Bladder. J Urol. 2009 Nov 12. [Epub ahead of print]PMID: 19913822
3. Raman JD, Bagrodia A, Bensalah K, Pearle MS, Lotan Y. Residual Fragments After Percutaneous Nephrolithotomy: Cost Comparison of Immediate Second Look Flexible Nephroscopy Versus Expectant Management. J Urol. 2009 Nov 12. [Epub ahead of print]PMID: 19913809
4. Lotan Y, Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG. The effect of the approach to radical prostatectomy on the profitability of hospitals and surgeons. BJU Int. 2009 Oct 28. [Epub ahead of print]PMID: 19874301
5. Bensalah K, Tuncel A, Raman JD, Bagrodia A, Pearle M, Lotan Y. How Physician and Patient Perceptions Differ Regarding Medical Management of Stone Disease. J Urol. 2009 Jul 17. [Epub ahead of print]. PMID: 19616801.
6. Bagrodia A, Gupta A, Raman JD, Bensalah K, Pearle MS, Lotan Y. Predictors of Cost and Clinical Outcomes of Percutaneous Nephrostolithotomy. J Urol. 2009 Aug;182(2):586-90. Epub 2009 Jun 17. PMID: 19535106.
7. Lotan Y, Elias K, Svatek RS, Bagrodia A, Nuss G, Moran B, Sagalowsky AI. Bladder Cancer Screening in a High Risk Asymptomatic Population Using a Point of Care Urine Based Protein Tumor Marker. J Urol. 2009 Jul;182(1):52-7; discussion 58. Epub 2009 May 17.PMID: 19450825.
8. Bagrodia A, Grover S, Srivastava A, Gupta A, Bolenz C, Sagalowsky AI, Lotan Y. Impact of body mass index on clinical and cost outcomes after radical cystectomy. BJU Int. 2009 Feb 9. [Epub ahead of print].
9. Raman JD, Bagrodia A, Gupta A, Bensalah K, Cadeddu JA, Lotan Y, Pearle MS. Natural history of residual fragments following percutaneious nephrostolithotomy. J Urol. 2009 Mar; 181(3):1163-8. Epub 2009 Jan 18. PMID: 19152935.
10. Nieder AM, Lotan Y, Nuss GR, Langston JP, Vyas S, Manoharan M, Soloway MS. Are patients with hematuria appropriately referred to Urology? A multi-institutional questionnaire based survey. Urol Oncol. 2008 Dec 19; [Epub ahead of print]. PMID: 19097811.
11. Bagrodia A, Raman JD, Bensalah K, Pearle MS, Lotan Y. Synchronous Bilateral Percutaneous Nephrostolithotomy: Analysis of Clinical Outcomes, Cost and Surgeon Reimbursement. J Urol. 2009 Jan;181(1):149-53. Epub 2008 Nov 13. PMID: 19012904.
12. Bagrodia A, Gupta A, Raman JD, Bensalah K, Pearle MS, Lotan Y. Impact of body mass index on cost and clinical outcomes after percutaneous nephrostolithotomy. Urology. 2008 Oct;72(4);756-60. Epub 2008 Aug 2. PMID: 18718645.
13. Lotan Y, Bagrodia A, Roehrborn CG, Scott J. Are urologists fairly reimbursed for complex procedures: failure of 22 modifier? Urology. 2008 Sep;72(3):494-7. Epub 2008 Jul 2. PMID: 18597834.
14. Lotan Y, Bensalah K, Ruddell T, Shariat SF, Sagalowsky AI, Ashfaq R. Prospective Evaluation of the clinical usefulness of reflex fluorescence in situt hybridization assay in patients with atypical cytology for the detection of urothelial carcinoma of the bladder. J Urol. 2008 Jun; 179(6):2164-9. Epub 2008 Apr 18. PMID: 18423745.
15. Bensalah K, Raman JD, Bagrodia A, Marvin A, Lotan Y. Does obesity impact the costs of partial and radical nephrectomy? J Urol. 2008 May; 179(5):1714-7; discussion 1718-8. Epub 2008 Mar 17. PMID: 18343428.
16. Lucas SM, Svatek RS, Olgin G, Arriaga Y, Kabbani W, Sagalowsky AI, Lotan Y. Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int. 2008 Jul;102(2):172-6 Epub 2008 Jul 1.
17. Malaeb BS, Rashid HH, Lotan Y, Khoddami SM, Shariat SF, Sagalowsky AI, McConnell JD, Roehrborn CG, Koeneman KS. Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts. Urol Oncol. 2007 Jul-Aug;25(4):291-7.
18. Stern JM, Svatek R, Park S, Hermann M, Lotan Y, Sagalowsky AI, Cadeddu JA. Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int. 2007 Aug;100(2):287-90.
19. Shariat SF, Ashfaq R, Karakiewicz PI, Saeedi O, Sagalowsky AI, Lotan Y. Survivin expression is associated with bladder cancer presence, stage, progression, and mortality. Cancer. 2007 March 15; 109(6): 1106-1113.
20. Park S, Jaffer O, Lotan Y, Saboorian H, Roehrborn CG, Cadeddu JA. Contemporary laparoscopic and open radical retropubic prostatectomy: pathologic outcomes and Kattan postoperative nomograms are equivalent. Urology. 2007 Jan;69(1):118-22.
21. Svatek RS, Lotan Y, Hermann M, Duchene DA, Sagalowsky AI, Cadeddu JA. The influence of clinical and pathological stage discrepancy on cancer specific survival in patients treated for renal cell carcinoma. J Urol. 2006 Oct;176(4):1321-5.
22. Svatek RS, Herman MP, Lotan Y, Casella R, Hsieh JT, Sagalowsky AI, Shariat SF. Soluble Fas-A promising novel urinary marker for the detection of recurrent superficial bladder cancer. Cancer. 2006 Mar 15.
23. Anderson JK, Murdock A, Cadeddu JA, Lotan Y. Cost Comparison of Laparoscopic versus Radical Retropubic Prostatectomy. Urology. 2005 Sep;66(3):557-60.
24. Svatek RS, Lee D, Lotan Y. Correlation of Office-Based Cystoscopy and Cytology with Histologic Diagnosis: How Good is the Gold Standard? Urology. 2005 Jul;66(1):65-8.
25. Shariat SF, Herman MP, Casella R, Lotan Y, Karam JA, Stenman UH. Urinary Levels of Tumor-Associated Trypsin Inhibitor (TATI) in the Detection of Transitional Cell Carcinoma of the Urinary Bladder. Eur Urol. 2005 Sep;48(3):424-31.
26. Khoddami SM, Shariat SF, Lotan Y, Saboorian H, McConnell JD, Sagalowsky AI, Roehrborn CG, Koeneman KS: Predictive value of primary Gleason pattern 4 in patients with Gleason score 7 tumours treated with radical prostatectomy. BJU Int. 2004 Jul;94(1):42-6.
27. Lotan Y, Shariat SF, Khoddami SM, Saboorian H, Koeneman KS, Cadeddu JA, Sagalowsky AI, McConnell JD, Roehrborn CG.: The percent of biopsy cores positive for cancer is a predictor of advanced pathologic stage and poor clinical outcomes in patients treated with radical prostatectomy. J Urol. 2004 Jun;171(6, Part 1 Of 2):2209-2214.
28. Shariat SF, Lotan Y, Saboorian H, Khoddami SM, Roehrborn CG, Slawin KM, Ashfaq R.: Survivin expression is associated with features of biologically aggressive prostate cancer. Cancer. 2004 Feb 15;100(4):751-7.