Post-op pelvic anatomy after RALP and open surgery

According to an article by Hirsch et al. in the inaugural issue of Practical Radiation Oncology (a new journal for radiation oncologists and their staff), there are some small but significant post-operative differences in pelvic anatomy between patients who undergo robot-assisted laparoscopic prostatectomy (RALP) as opposed to standard, open forms of radical prostatectomy. These differences may be critically important to the delivery of adjuvant or salvage radiation therapy as follow-up treatment for high-risk patients.

In a media release issued by Boston University, Dr. Hirsch explains that, based on their careful analysis of MRI data from 10 men who had had open prostatectomies and 15 men who had had RALPs, they found a number of clinically relevant differences between post-surgical separation of different tissue groups such as the separation of the bladder from the rectum. She goes on to emphasize the importance of “careful attention … in planning the posterior and lateral margins [of adjuvant radiation therapy] to ensure that coverage is sufficient” in men who have been treated with RALP.

The technical details of the proposed modifications to margins for adjuvant radiation therapy are given in the paper by Hirsch et al. The learning for the patient is that the type of surgery may affect the treatment planning and delivery of adjuvant radiation therapy. Clearly the wise patient will make sure that his radiation oncologist knows exactly what type of surgery was performed and request that treatment planning takes careful account of the fact that the type of surgery can and does impact anatomy. This, in turn, should affect radiation treatment planning.

2 Responses

  1. So what, exactly, were the “number of clinically relevant differences between post-surgical separation of different tissue groups such as the separation of the bladder from the rectum?” I imagine the separation of the gland from the rectal wall would be included. Was the RALP much cleaner/closer than open? And because of this cleaner/closer separation, is it this that hampers salvage RT of RALP patients? Somewhat confusing.

  2. Chuck:

    I don’t think there is any issue about salvage EBRT for RALP patients being “hampered.” What this paper is saying is that EBRT planning for RALP patients needs to take account of slight anatomic differences resulting from RALP as compared to the older, open procedures. The full text of the paper undoubtedly gives greater detail, but my suspicion is that this all has to do with the angles of surgical dissection and (possibly) the inflation of the abdomen with gas to improve visibility for the surgeon. We are talking millimeters here, not even a centimeter.

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