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Björklund J, Stattin P, Rönmark E, Aly M, Akre O. The 90-day cause-specific mortality after radical prostatectomy: a nationwide population-based study. BJU Int 2021; 129:318-324. [PMID: 34191407 DOI: 10.1111/bju.15533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the cause-specific mortality in the postoperative period after radical prostatectomy (RP) for prostate cancer (PCa). METHODS In the National Prostate Cancer Register of Sweden (NPCR), we identified all men who died within 90 days after RP performed 1998-2018 and we assessed cause of death in a chart review. We compared the adjudications of death from our medical record review with those in in the Swedish Cause of Death Registry (CDR). RESULTS Out of 44 635, 58 (0.13%) men who had undergone RP from 1998 through 2018 died within 90 days after RP. Per medical record review the most common causes of death were cardiac disease (30%) and venous thromboembolic events (VTE; 21%). No men died of metastatic PCa as was first indicated in the CDR. After robot-assisted RP (RARP) or open retropubic RP (RRP), the postoperative mortality was 0.09% (19/21 520) and 0.19% (37/19 635), respectively. The effect off modality was confounded mainly by year of surgery, age at surgery, Charlson Comorbidity Index score and the concomitant pelvic lymph node dissection. CONCLUSION The validated absolute 90-day mortality after RP was 1.3/1000 during the 21-year study period. Cardiovascular diseases were the most common causes of death after RP. Our validation of the CDR refuted the occurrence of postoperative deaths from metastatic PCa. There were differences in rates and type of mortality between RRP and RARP, but the RARP cohort was more recent than the RRP cohort, which likely explain the differences.
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Affiliation(s)
- Johan Björklund
- Urology, The Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Rönmark
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Aly
- Urology, The Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Urology, The Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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2
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Björklund J, Folkvaljon Y, Cole A, Carlsson S, Robinson D, Loeb S, Stattin P, Akre O. Postoperative mortality 90 days after robot-assisted laparoscopic prostatectomy and retropubic radical prostatectomy: a nationwide population-based study. BJU Int 2016; 118:302-6. [PMID: 26762928 DOI: 10.1111/bju.13404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess 90-day postoperative mortality after robot-assisted laparoscopic radical prostatectomy (RARP) and retropubic radical prostatectomy (RRP) using nationwide population-based registry data. PATIENTS AND METHODS We conducted a cohort study using the National Prostate Cancer Register of Sweden, including 22 344 men with localized prostate cancer of clinical stage T1-T3, whose prostate-specific antigen levels were <50 μg/mL and who had undergone primary radical prostatectomy in the period 1998-2012. Vital status was ascertained through the Total Population Register. The rates for 90-day postoperative mortality were analysed using logistic regression analysis, and comparisons of 90-day mortality with the background population were made using standardized mortality ratios (SMRs). RESULTS Of the 14 820 men who underwent RRP, 29 (0.20%) died, and of the 7 524 men who underwent RARP, 10 (0.13%) died. Mortality in the cohort during the 90-day postoperative period was lower than in an age-matched background population: SMR 0.57 (95% confidence interval [CI] 0.39-0.75). There was no statistically significant difference in 90-day mortality according to surgical method: RARP vs RRP odds ratio (OR) 1.14; 95% CI 0.46-2.81. Postoperative 90-day mortality decreased over time: 2008-2012 vs 1998-2007 OR 0.44; 95% CI 0.21-0.95, mainly because of lower mortality after RARP. CONCLUSION The 90-day postoperative mortality rates were low after RARP and RRP and there was no statistically significant difference between the methods. Given the long life expectancy among men with low- and intermediate-risk prostate cancer, very low postoperative mortality is a prerequisite for RP, which was fulfilled by both RRP and RARP. The selection of healthy men for RP is highlighted by the lower 90-day mortality after RP compared with the background population.
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Affiliation(s)
- Johan Björklund
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Yasin Folkvaljon
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Alexander Cole
- Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Carlsson
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - David Robinson
- Department of Urology, Ryhov County Hospital, Jönköping, Sweden.,Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Stacy Loeb
- Department of Urology Population Health, the Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA
| | - Pär Stattin
- Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Olof Akre
- Department of Urology, Karolinska University Hospital, Solna, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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3
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Huang KH, Carter SC, Hu JC. Does robotic prostatectomy meet its promise in the management of prostate cancer? Curr Urol Rep 2014; 14:184-91. [PMID: 23564268 DOI: 10.1007/s11934-013-0327-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Following Walsh's advances in pelvic anatomy and surgical technique to minimize intraoperative peri-prostatic trauma more than 30 years ago, open retropubic radical prostatectomy (RRP) evolved to become the gold standard treatment of localized prostate cancer, with excellent long-term survival outcomes [1•]. However, RRP is performed with great heterogeneity, even among high volume surgeons, and subtle differences in surgical technique result in clinically significant differences in recovery of urinary and sexual function. Since the initial description of robotic-assisted radical prostatectomy (RARP) in 2000 [2], and U.S. Food and Drug Administration approval shortly thereafter, RARP has been rapidly adopted and has overtaken RRP as the most popular surgical approach in the management of prostate cancer in the United States [3]. However, the surgical management of prostate cancer remains controversial. This is confounded by the idolatry of new technologies and aggressive marketing versus conservatism in embracing tradition. Herein, we review the literature to compare RRP to RARP in terms of perioperative, oncologic, and quality-of-life outcomes as well as healthcare costs. This is a particularly relevant, given the absence of randomized trials and long-term (more than 10-year) follow-up for RARP biochemical recurrence-free survival.
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Affiliation(s)
- Kuo-How Huang
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd, Suite 1000, Los Angeles, CA 90024, USA
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4
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Hugosson J, Stranne J, Carlsson SV. Radical retropubic prostatectomy: a review of outcomes and side-effects. Acta Oncol 2011; 50 Suppl 1:92-7. [PMID: 21604947 DOI: 10.3109/0284186x.2010.535848] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Radical prostatectomy (RP) is worldwide probably the most common procedure to treat localized prostate cancer (PC). Due to a more widespread use of Prostate-Specific Antigen (PSA) testing, patients operated today are often younger and have organ confined disease justifying a more preservative surgery. At the same time, surgical technique has improved resulting in lower risk of permanent side-effects. This paper aims to give an overview of results from modern surgery regarding cancer control and side-effects. A brief overview of the history is given. MATERIAL AND METHODS A literature research identified recently published papers focusing on outcome and side-effects after RP. RESULTS One large randomized study (SPCG-4) compared RP and watchful waiting (WW). The study showed that RP was superior to WW in preventing local progression (RR = 0.36), distant metastasis (RR = 0.65) and death from PC (RR = 0.65). Observational studies also show a better outcome for men treated with RP compared to WW. Peri-operative mortality after RP is low in most material around 0.1%. The risk of stricture of the vesico-urethral anastomosis has decreased with improved technique from historically 10-20% to a low incidence of around 2-9% today. Also the risk of incontinence has declined with improved technique. However, while the rates of severe incontinence is usually very low, as many as 30% still report light incontinence after long-term follow-up. Erectile dysfunction (ED) is still a frequent side-effect after RP. This risk is dependent on age, pre-operative sexual function, surgical technique and other risk factors for ED such as smoking, diabetes, etc. In selected subgroups the risk of ED is low. Inguinal hernia is a more recently described complication after open retropubic RP with a postoperative incidence of 15-20% within three years of surgery. CONCLUSION RP is an effective method to achieve cancer control in selected patients. With modern technique it is a safe procedure with a low risk of permanent side-effects except for ED.
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Affiliation(s)
- Jonas Hugosson
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at University of Gothenburg, Bruna Stråket 11 B, Göteborg, Sweden.
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5
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Carlsson S, Adolfsson J, Bratt O, Johansson JE, Ahlstrand C, Holmberg E, Stattin P, Hugosson J. Nationwide population-based study on 30-day mortality after radical prostatectomy in Sweden. ACTA ACUST UNITED AC 2009; 43:350-6. [DOI: 10.3109/00365590902916930] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sigrid Carlsson
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ola Bratt
- Department of Urology, Lund University Hospital, Sweden
| | - Jan-Erik Johansson
- Department of Clinical Medicine, Division of Urology and Center for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden
| | - Christer Ahlstrand
- Department of Biomedicine and Surgery, Division of Urology, Faculty of Health Science, Linköping University Hospital, Linköping, Sweden
| | - Erik Holmberg
- Oncological Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cittanova-Pansard ML, Droupy S, Susen S, Boiteux JP, Marret E, Laversin S, Doublet JD. Prévention de la maladie thromboembolique en chirurgie urologique. ACTA ACUST UNITED AC 2005; 24:902-10. [PMID: 16006092 DOI: 10.1016/j.annfar.2005.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Few scientific evidences are available in the literature, and the methodologic quality of the studies is often under average. Nevertheless, the conclusions are the following. Nephrectomy, renal transplantation, open surgery of the lower urinary tract and lumbar or pelvic lymph nodes dissection are at high risk for thromboembolic events. Other open or endoscopic urological procedures are at low risk. The laparoscopic approach doesn't change the risk associated with the procedure itself. Thromboprophylaxis is recommended in high-risk procedures. There was no evidence to recommend starting the prophylaxis before more than after the procedure. The use of low molecular weight heparin is recommended for prophylaxis. It can be associated with compressive stockings. It is recommended to treat for around seven days after the procedure. In case of cancer surgery, prophylaxis could be needed for four to six weeks.
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Gillitzer R, Thüroff JW. Relative advantages and disadvantages of radical perineal prostatectomy versus radical retropubic prostatectomy. Crit Rev Oncol Hematol 2002; 43:167-90. [PMID: 12191739 DOI: 10.1016/s1040-8428(02)00016-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In recent years prostate cancer has become the predominant malignancy in men. With the introduction of prostate specific antigen (PSA) the disease can be diagnosed at an early stage, at which surgical therapy can be curative. In the past century, the retropubic and the perineal routes were established as alternatives of surgical access to the gland for clinically localized prostate cancer. The selection of the operative route is mostly decided individually on the basis of surgical training and experience. The revived interest in perineal radical prostatectomy is explained by the fact that this technique has been associated with low morbidity. The differences of both surgical approaches of radical prostatectomy are elucidated and compared regarding tumor control and short and long term complication rates. Taking these results into consideration, specific advantages and disadvantages of radical perineal prostatectomy are emphasized.
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Affiliation(s)
- R Gillitzer
- Department of Urology, Johannes-Gutenberg University, Langenbeckstrasse 1, Mainz, Germany.
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8
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Galalae RM, Kovács G, Schultze J, Loch T, Rzehak P, Wilhelm R, Bertermann H, Buschbeck B, Kohr P, Kimmig B. Long-term outcome after elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for locally advanced prostate cancer. Int J Radiat Oncol Biol Phys 2002; 52:81-90. [PMID: 11777625 DOI: 10.1016/s0360-3016(01)01758-8] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the 8-year outcome of local dose escalation using high-dose-rate conformal brachytherapy combined with elective irradiation of the pelvic lymphatics for localized prostate cancer. METHODS AND MATERIALS One hundred forty-four consecutively treated men (1986-1992) were recorded prospectively. Twenty-nine (20.14%) patients had T1b-2a tumors, and 115 (79.86%) patients had T2b-3 tumors according to, respectively, American Joint Committee on Cancer/Union Internationale Contre le Cancer 1992. All patients had a negative nodal status, proven by CT or MRI. The mean initial PSA value was 25.61 ng/mL (Initial value for 41.66% of patients was <10 ng/mL, for 21.52% was 10-20 ng/mL, and for 32.63% was >20 ng/mL). The total dose applied by external beam radiotherapy was 50 Gy in the pelvis and 40 Gy in the prostate. The high-dose-rate brachytherapy was delivered in two fractions, which were incorporated into the external beam treatment (after 20-Gy and 40-Gy external beam radiotherapy dose). The dose per fraction was 15 Gy for the PTV1 (peripheral prostate zone) and 9 Gy for the PTV2 (entire prostatic gland). Any patient free of clinical or biochemical evidence of disease was termed bNED. Actuarial rates of outcome were calculated by Kaplan-Meier and compared using the log-rank. Cox regression models were used to establish prognostic factors of the various measures of outcome. RESULTS The median follow-up was 8 years (range 60-171 months). The overall survival rate was 71.5%, and the disease-free survival rate was 82.6%. The bNED survival rate was 72.9%. Freedom from local recurrence for T3 stage was 91.3%, whereas for G3 lesions it was 88.23%. Freedom from distant recurrence for T3 stage was 82.6% and for G3 lesions 70.59%. Univariate survival analyses revealed that low stage (T1-2), low grade (G1-2), no hormonal therapy, initial PSA value less than 40 ng/mL, and PSA normalization <1.0 ng/mL after irradiation were associated with long survival. In multivariate analyses, initial PSA value, PSA kinetics after radiation therapy, and no adjuvant hormonal treatment were independent prognostic factors. Grade 3 late radiation toxicity (according to RTOG/EORTC scoring scheme) was 2.3% for the genitourinary system in terms of cystitis and 4.10% for the gastrointestinal system in terms of proctitis. Grades 4 and 5 genitourinary/gastrointestinal morbidity was not observed. A history of transurethral resection of the prostate with a median interval of less than 6 months from radiotherapy was associated with a high risk of genitourinary toxicity. CONCLUSION The 8-year results confirm the feasibility and effectiveness of combined elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for cure of localized and especially high-risk prostate cancer.
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Affiliation(s)
- Razvan M Galalae
- Interdisciplinary Brachytherapy Center, Clinic for Radiation Therapy (Radio-oncology), University Hospital, Christian-Albrechts-University, Kiel, Germany.
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9
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Riedel JE, Lynch W, Baase C, Hymel P, Peterson KW. The effect of disease prevention and health promotion on workplace productivity: a literature review. Am J Health Promot 2001; 15:167-91. [PMID: 11265580 DOI: 10.4278/0890-1171-15.3.167] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This report was prepared by the Center for Disease Prevention and Health Promotion in the Institute for Health and Productivity Management as part of an effort to improve understanding of the connection between employee health and performance and to begin to identify new strategies through which treating health as an investment in human capital can lead to greater business success. Computer database searches of peer-reviewed literature published between 1993 and 1998 and manual reviews of 20 journals were used to identify research on the link between employee health and performance. Data was extracted to summarize the overall findings on the magnitude of health problems addressed by health promotion and disease prevention programs, and the impact of interventions on improving health risk, reducing medical care cost, and improving worker performance. From this summary, major conclusions on early detection of disease, the impact of behavior change programs, and appropriate care-seeking were drawn. This systematic review is supplemented with summaries of 15 seminal articles and descriptions of five leading-practices programs. The influence of developments in work/family issues, complementary and alternative medicine, and quality of care and health outcomes research are briefly discussed. Finally, a conceptual framework for studying the impact of health and productivity is described.
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Affiliation(s)
- J E Riedel
- Riedel & Associates, Conifer, Colorado, USA
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10
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MULTICENTER PATIENT SELF-REPORTING QUESTIONNAIRE ON IMPOTENCE, INCONTINENCE AND STRICTURE AFTER RADICAL PROSTATECTOMY. J Urol 2000. [DOI: 10.1097/00005392-200003000-00034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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KAO TZUCHEG, CRUESS DAVIDF, GARNER DANIEL, FOLEY JOHN, SEAY THOMAS, FRIEDRICHS PAUL, THRASHER JBRANTLEY, MOONEYHAN RENEED, McLEOD DAVIDG, MOUL JUDDW. MULTICENTER PATIENT SELF-REPORTING QUESTIONNAIRE ON IMPOTENCE, INCONTINENCE AND STRICTURE AFTER RADICAL PROSTATECTOMY. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67819-6] [Citation(s) in RCA: 164] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- TZU-CHEG KAO
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - DAVID F. CRUESS
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - DANIEL GARNER
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - JOHN FOLEY
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - THOMAS SEAY
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - PAUL FRIEDRICHS
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - J. BRANTLEY THRASHER
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - RENEE D. MOONEYHAN
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - DAVID G. McLEOD
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
| | - JUDD W. MOUL
- From the Department of Preventive Medicine and Biometrics, Division of Epidemiology and Biostatistics, and Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences and Radiation Oncology Department, National Naval Medical Center, Bethesda and Departments of Urology, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland, Urology Department, Brooke Army Medical Center, Ft. Sam Houston and Wilford Hall United States Air Force Medical
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12
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Arai Y, Egawa S, Tobisu K, Sagiyama K, Sumiyoshi Y, Hashine K, Kawakita M, Matsuda T, Matsumoto K, Fujimoto H, Okada T, Kakehi Y, Terachi T, Ogawa O. Radical retropubic prostatectomy: time trends, morbidity and mortality in Japan. BJU Int 2000; 85:287-94. [PMID: 10671883 DOI: 10.1046/j.1464-410x.2000.00468.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the time trends, morbidity and mortality of contemporary anatomical radical retropubic prostatectomy (RRP) in a multi-institutional study in Japan, where RRP has become more popular in the last decade. PATIENTS AND METHODS Between January 1991 and August 1998, 638 patients underwent RRP at seven urological centres in Japan. Major complications (within 30 days of surgery) and the 30-day mortality were reviewed retrospectively. Of the patients, 12.9% were < 60 years old, 56.3% were 60-69 years old and 30.9% were >/= 70 years old (median age 67). Results The number of RRPs increased markedly, by more than sevenfold, from 1991-92 to 1996-97, mainly because there were more patients undergoing RRP in their sixth decade. The contribution of T1c disease increased in absolute and relative terms, from 13.9% in 1991-92 to 37.9% in 1997-98. Over time, the mean blood loss and the allogeneic transfusion rate decreased steadily. There was a trend toward more favourable outcomes for pathological variables (an increased percentage of organ-confined disease, decreased margin positivity and a decreased incidence of positive lymph node metastasis). The most common complications were wound-related (7.5%), or anastomotic leakage (4.1%). Major cardiopulmonary complications occurred in only two patients (0.31%, both pulmonary embolisms). One patient died from cerebral haemorrhage within 30 days of surgery, giving a mortality rate of 0.16%. CONCLUSION s This study indicates a trend towards selecting patients most likely to benefit from RRP. Although the procedure is technically demanding, it can have an acceptably low rate of early complications, little mortality and need for allogeneic transfusion. The assessment of morbidity suggests a lower incidence of catastrophic thrombo-embolic and cardiac complications in Japanese patients than in Western men. The present data may be useful in decision-analysis models evaluating the role of therapy for Asian men with early-stage prostate cancer.
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Affiliation(s)
- Y Arai
- Departments of Urology, Kurashiki Central Hospital, Kurashiki, Japan
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13
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Jacqmin D. [Indications and results of radical prostatectomy]. Cancer Radiother 1998; 1:418-22. [PMID: 9587371 DOI: 10.1016/s1278-3218(97)89562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radical prostatectomy is the surgical curative treatment of localized prostate cancer. The survival is good in young patients (< 70) with T2 N0M0 tumors and more than 10 year's life expectancy. Side-effects are urinary incontinence, impotence and anastomosis stricture. Quality of life should be considered as an important factor for the choice of the patient between radical prostatectomy, radiotherapy and follow-up.
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Affiliation(s)
- D Jacqmin
- Service de chirurgie urologique, Hôpitaux universitaires de Strasbourg, France
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15
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Dillioglugil O, Leibman BD, Leibman NS, Kattan MW, Rosas AL, Scardino PT. Risk Factors for Complications and Morbidity After Radical Retropubic Prostatectomy. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64856-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ozdal Dillioglugil
- From the Matsunaga-Conte Prostate Cancer Research Center and Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas
| | - Bryan D. Leibman
- From the Matsunaga-Conte Prostate Cancer Research Center and Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas
| | - Neville S. Leibman
- From the Matsunaga-Conte Prostate Cancer Research Center and Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas
| | - Michael W. Kattan
- From the Matsunaga-Conte Prostate Cancer Research Center and Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas
| | - Alejandro L. Rosas
- From the Matsunaga-Conte Prostate Cancer Research Center and Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas
| | - Peter T. Scardino
- From the Matsunaga-Conte Prostate Cancer Research Center and Scott Department of Urology, Baylor College of Medicine and Anesthesiology Service, Methodist Hospital, Houston, Texas
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Sall M, Madsen FA, Rhodes PR, Jønler M, Messing EM, Bruskewitz RC. Pelvic pain following radical retropubic prostatectomy: a prospective study. Urology 1997; 49:575-9. [PMID: 9111628 DOI: 10.1016/s0090-4295(96)00570-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate subacute and chronic pelvic pain after radical retropubic prostatectomy (RRP) performed for clinically localized prostate cancer. METHODS Twenty-four consecutive patients undergoing RRP completed pain, quality-of-life, and incontinence questionnaires. They also wore pads for 24 hours to measure urine loss objectively before and after surgery. RESULTS Three patients had pelvic pain preoperatively. Thirteen, 7, and 5 patients had pelvic pain at 1, 3, and 6 months, respectively, after RRP. At 6 months, none of the 5 patients with pelvic pain required analgesic medication. There was a strong relationship between pain and cancer worry, as well as between pain and incontinence. CONCLUSIONS Many patients have subacute pelvic pain after RRP but improve over time. Severe chronic pain is unlikely after RRP.
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Affiliation(s)
- M Sall
- Department of Surgery, University of Wisconsin, Madison 53792, USA
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17
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New Use of Foley Catheter for Precise Vesicourethral Anastomosis during Radical Retropubic Prostatectomy. J Urol 1996. [DOI: 10.1097/00005392-199604000-00068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Petroski RA, Thrasher JB, Hansberry KL. New Use of Foley Catheter for Precise Vesicourethral Anastomosis during Radical Retropubic Prostatectomy. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66271-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rayford A. Petroski
- Department of Surgery, Division of Urology, Madigan Army Medical Center, Tacoma, Washington
| | - J. Brantley Thrasher
- Department of Surgery, Division of Urology, Madigan Army Medical Center, Tacoma, Washington
| | - Kurt L. Hansberry
- Department of Surgery, Division of Urology, Madigan Army Medical Center, Tacoma, Washington
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19
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Etzioni R, Thompson IM. Prostate cancer and computer models: Background, limitations, and potential. Urol Oncol 1996; 2:57-64. [DOI: 10.1016/s1078-1439(96)00047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Affiliation(s)
- P C Prorok
- Biometry Branch DCPC, National Cancer Institute, Bethesda, MD 20892-7394, USA
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21
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Affiliation(s)
- S H Woolf
- Department of Family Practice, Fairfax Family Practice Center, Medical College of Virginia 22033, USA
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